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目的探讨液基细胞学在超声支气管镜引导下经支气管纵隔淋巴结针吸活检术(EBUS-TBNA)中的诊断价值。方法前瞻性分析2012年6月至2013年9月四川大学华西医院呼吸与危重症医学科行EBUS-TBNA检查的600例患者。患者在局部麻醉和中度镇静的情况下,行EBUS-TBNA获取病理组织以及细胞学标本。对每例患者的抽吸活检组织均进行薄层液基细胞学检查及传统细胞学涂片。必要时,组织细胞采用免疫组化方法进行分析诊断并与组织学诊断进行比较。结果组织学检查确诊480例恶性肿瘤以及120例良性病变。Sure Path液基细胞学检查术与传统巴氏涂片法敏感性分别为82.1%和56.0%,特异性分别为87.5%和82.5%,阳性预测值分别为96.3%和92.8%,阴性预测值分别为54.9%和31.9%,差异有统计学意义(P<0.05)。两者联合特异性为100.0%。结论液基细胞学检测能提升EBUS-TBNA的细胞学检测的诊断价值。细胞学检测结果难以确诊时,需进行组织学检测。
Objective To investigate the diagnostic value of liquid-based cytology in transbronchial needle aspiration biopsy (EBUS-TBNA) guided by ultrasound bronchoscopy. Methods A prospective analysis of 600 patients with EBUS-TBNA in Huaxi Hospital of Respiratory and Critical Care Medicine from June 2012 to September 2013 was conducted. Patients underwent local anesthesia and moderate sedation, the line EBUS-TBNA to obtain pathological tissue and cytology specimens. Aspiration biopsy was performed on each patient by thin-layer liquid-based cytology and conventional cytology smears. If necessary, the tissue cells are analyzed by immunohistochemistry and compared with histological diagnosis. Results Histological examination confirmed 480 cases of malignant tumors and 120 cases of benign lesions. The sensitivity of Sure Path liquid-based cytology was 82.1% and 56.0% respectively with specificity of 87.5% and 82.5%, respectively. The positive predictive values were 96.3% and 92.8% respectively. The negative predictive values were 54.9% and 31.9% respectively, the difference was statistically significant (P <0.05). The combined specificity of the two was 100.0%. Conclusion Liquid-based cytological examination can improve the diagnostic value of cytological detection of EBUS-TBNA. Cytological test results difficult to diagnose, the need for histological testing.