纤维支气管镜肺活检和痰液脱落细胞学检查对肺周围孤立性肿块的诊断价值

摘要

目的 探讨纤维支气管镜肺活检和痰液脱落细胞学检查对肺周围孤立性肿块的诊断价值.方法 选择2013年1月至2015年8月于湖北医药学院附属东风医院诊治的肺周围孤立性肿块患者120例,根据病理诊断结果分为肺癌组(40例)和良性病变组(80例),所有患者均进行纤维支气管镜肺活检与痰液脱落细胞学检查,比较2种方法对肺癌和良性病变的检出率以及诊断敏感度、特异度和准确率.结果 纤维支气管镜对肺癌与良性病变的检出率比较[97.5％ (39/40)比100.0％ (80/80)],差异无统计学意义(P＞0.05),细胞学检查对肺癌的检出率低于对良性病变的检出率[80.0％ (32/40)比97.5％ (78/80)],差异有统计学意义(P＜0.05).纤维支气管镜对肺周围孤立性肿块的诊断敏感度、特异度与准确率分别为97.5％、100.0％和99.2％,而痰液脱落细胞学的诊断敏感度、特异度与准确率分别为80.0％、97.5％和91.7％.纤维支气管镜对肺周围孤立性肿块的诊断敏感度明显高于痰液脱落细胞学,差异有统计学意义(P＜0.05).结论 纤维支气管镜肺活检对肺周围孤立性肿块的诊断敏感度高于细胞学检查,临床建议二者联合使用.%Objective To investigate diagnostic value of fiberoptic bronchoscopy (FOB)lung biopsy and sputum cytology examination for peripheral solitary pulmonary mass.Methods Totally 120 patients with peripheral solitary pulmonary mass from January 2013 to August 2015 in Dongfeng Hospital Affiliated to Hubei University of Medicine were divided into 2 groups according to pathologic diagnosis:lung cancer group (40 cases) and benign lesion group (80 cases).All patients had FOB lung biopsy and sputum cytology examination.Detective rates,sensitivities,specificities and accuracies of diagnosis were analyzed.Results Detective rates of FOB lung biopsy for lung cancer and benign lesion had no significant difference [97.5％ (39/40) vs 100.0％ (80/80),P ＞ O.05];detective rate of sputum cytology eximation for lung cancer was significantly lower than that for benign lesion[80.0％(32/40)vs 97.5％ (78/80),P ＜0.05].In the diagnosis of peripheral pulmonary solitary mass,the sensitivity,specificity and accuracy of FOB lung biopsy were 97.5％,100.0％ and 99.2％ respectively;the sensitivity,specificity and accuracy of sputum cytology eximation were 80.0％,97.5％ and 91.7％ respectively;the sensitivity of FOB lung biopsy was significantly higher than that of sputum cytology eximation(P ＜ 0.05).Conclusion The FOB lung biopsy has higher diagnostic sensitivity than sputum cytology eximation for peripheral solitary pulmonary mass.