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目的探讨纤维支气管镜下黏膜及肺活检、CT引导下经皮肺活检、痰液病理细胞学检查对不明原因肺部肿块的诊断价值。方法回顾性分析不明原因肺部肿块住院病人101例。结果101例患者中行纤支镜检查73例,CT引导下经皮肺活检18例,其中10例完成上述两种检查,纤支镜与经皮肺活检诊断符合率70%。经病理学明确恶性肿瘤诊断54例。中央型肿块纤支镜检灵敏度为88%(21/24),特异度为100%(3/3);周围型肿块纤支镜检灵敏度为43%(10/23),特异度为100%(21/21);CT引导下经皮肺活检灵敏度及特异度分别为80%(8/10)和100%(8/8)。经皮肺活检并发症发生率为22%,高于纤支镜检的12%,且有严重并发症产生。30%患者行痰液病理细胞学检查,阳性率6%。结论痰液的病理细胞学检查简便易行且费用低廉,但阳性率偏低。中央型肿块首选纤支镜下黏膜及肺活检。周围型肿块应根据肿块部位及大小决定先行纤支镜检查还是先行经皮肺活检。
Objective To investigate the diagnostic value of bronchoscopic mucosa and lung biopsy, CT-guided percutaneous lung biopsy and sputum cytology in the diagnosis of lung masses with unknown causes. Methods Retrospective analysis of 101 patients with unexplained pulmonary masses in hospital. Results Of the 101 cases, 73 cases underwent fiberoptic bronchoscopy and 18 cases underwent CT-guided percutaneous lung biopsy. Of the 10 cases, the above two tests were performed. The accuracy of bronchofiberscopy and percutaneous lung biopsy was 70%. 54 cases of malignant tumors diagnosed by pathology. The sensitivity of bronchofiberscopy in central mass was 88% (21/24) and the specificity was 100% (3/3). The sensitivity of bronchofiberscopy in peripheral mass was 43% (10/23) and the specificity was 100% (21/21). The sensitivity and specificity of CT guided percutaneous lung biopsy were 80% (8/10) and 100% (8/8) respectively. The incidence of percutaneous pulmonary biopsy complications was 22%, higher than 12% of bronchoscopy, and serious complications. Thirty patients with sputum pathology cytology, the positive rate of 6%. Conclusion The pathological cytology of sputum is simple, easy and cost-effective, but the positive rate is low. Central mass preferred bronchoscopic mucosa and lung biopsy. Peripheral mass should be based on the tumor mass and size of the site to determine the first fiberoptic bronchoscopy or percutaneous lung biopsy.