超声引导下粗针活检在肺周围型占位病变诊断中的应用

发布时间：2018-12-13 22:40

【摘要】：目的:探讨超声引导下粗针活检术结合免疫组化及基因学检测在肺周围型占位病变诊断中的应用价值。方法:分析2014年3月—2016年12月入组的89例初诊为肺周围型占位病变患者的资料,并按照病灶大小进行分组,分析超声引导下肺肿块粗针活检对肺占位良恶性诊断准确率、分型(分类)诊断准确率、表皮生长因子受体(epidermal growth factor receptor,EGFR)诊断阳性率。结果:89例中确诊腺癌37例、鳞癌31例、肉瘤样癌4例、神经内分泌癌4例、腺鳞癌1例、未分化肉瘤1例、B细胞型淋巴瘤1例、小细胞癌1例、炎症5例、2例结合基因学检测分别诊断为转移性滑膜肉瘤和结外黏膜相边缘区B细胞淋巴瘤。2例未能分型,其中1例诊断为非小细胞癌,1例诊断为低分化癌。有2例炎症病例经临床随访后因高度怀疑肺癌而行二次穿刺活检后分别诊断为腺癌和腺鳞癌。31例肺癌患者活检小标本行EGFR基因突变检测,检测到EGFR基因突变11例。5例肺癌患者活检小标本行间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)基因异位检测,均为阴性。良恶性诊断准确率为97.75%(87/89)、分型(分类)诊断准确率为95.35%(82/86)、EGFR诊断阳性率为34.38%(11/31),各组之间没有统计学差异(P0.05)。89例患者仅有2例发生少量咳血症状,并发症发生率2.2%。结论:对于周围型肺占位,超声引导下粗针活检术具有简便、安全、易推广的优势,结合免疫组化及基因学检测对病变的诊断及指导治疗有较高的临床价值。
[Abstract]:Objective: to evaluate the value of ultrasound guided coarse needle biopsy combined with immunohistochemical and genetic detection in the diagnosis of peripulmonary lesions. Methods: the data of 89 patients with peripulmonary space occupying lesions from March 2014 to December 2016 were analyzed and divided into groups according to the size of the lesions. The accuracy of ultrasound guided coarse needle biopsy in the diagnosis of benign and malignant lung masses was analyzed. Typing (classification) diagnostic accuracy, epidermal growth factor receptor (epidermal growth factor receptor,EGFR) diagnostic positive rate. Results: there were 37 cases of adenocarcinoma, 31 cases of squamous cell carcinoma, 4 cases of sarcomatoid carcinoma, 4 cases of neuroendocrine carcinoma, 1 case of adenosquamous carcinoma, 1 case of undifferentiated sarcoma, 1 case of B-cell lymphoma, 1 case of small cell carcinoma and 5 cases of inflammation. Two cases were diagnosed as metastatic synovial sarcoma and B cell lymphoma in the marginal zone of extracellular mucosa, 2 cases were diagnosed as non-small cell carcinoma, 1 case was diagnosed as non-small cell carcinoma, and 1 case was diagnosed as poorly differentiated carcinoma. Two cases of inflammation were diagnosed as adenocarcinoma and adenosquamous carcinoma after double biopsy because of high suspicion of lung cancer after clinical follow-up. 31 small biopsy specimens of lung cancer were detected for mutation of EGFR gene. The mutation of EGFR gene was detected in 11 cases, and the heterotopic detection of (anaplastic lymphoma kinase,ALK gene in 5 small biopsy specimens of lung cancer was negative. The accuracy of benign and malignant diagnosis was 97.75% (87 / 89), the accuracy of classification was 95.35% (82 / 86), EGFR), the positive rate of diagnosis was 34.38% (11 / 31). There was no statistical difference between the groups (P0.05). Only 2 cases of 89 patients developed a small amount of hemoptysis, the incidence of complications was 2.2%. Conclusion: ultrasound guided coarse needle biopsy is simple, safe and easy to popularize for peripheral lung mass. Combined with immunohistochemistry and gene detection, it has a high clinical value in the diagnosis and treatment of lesions.
【作者单位】：南通市肿瘤医院超声科;南通市肿瘤医院病理科;南通市肿瘤医院内科;
【基金】：南通市社会事业科技创新与示范计划(HS13908)
【分类号】：R445.1;R734.2

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