EBUS-TBNA结合免疫组化在老年肺癌诊断中的应用

发布时间：2018-07-16 19:41

【摘要】：目的评价超声支气管镜引导下的经支气管针吸活检(EBUS-TBNA)结合免疫组化在老年肺癌诊断中的作用,并对EBUS-TBNA确诊的非小细胞肺癌(NSCLC)患者进行表皮生长因子(EGFR)基因突变检测,以期实现后续合理的个体化靶向治疗。方法经胸部CT检查示纵隔或肺门淋巴结肿大或胸内包块的老年患者61例,行EBUS-TBNA结合免疫组化检查,对穿刺的部位分布、EBUS-TBNA诊断分型、不同检测方法的阳性率、并发症及患者满意度等进行研究,并对EBUS-TBNA确诊的NSCLC患者进行EGFR基因突变检测,并对非小细胞肺癌不同分型间的EGFR基因突变差异进行分析。结果 61例老年患者共90个穿刺部位,其中4R、7、11R为最常累及的淋巴结,EBUS-TBNA常规病理学+免疫组化的穿刺阳性率显著高于常规病理学检查(94.44%vs 82.22%,χ~2=6.523,P=0.011);经EBUS-TBNA确诊58例,诊断肺癌的准确度为95.08%,敏感性为94.29%,特异性为100%。在最终临床确诊的35例肺癌老年患者中,常规病理学+免疫组化检测的阳性率高于常规病理学检测,但两者间的差异仅在肺腺癌的病例中有统计学意义(χ~2=4.286,P=0.038);在EBUS-TBNA诊断的肺癌中,仅有7例(11.48%)患者发生轻微并发症。所有患者麻醉满意度、手术满意度以及术后24 h的满意度均表现良好。在EBUS-TBNA确诊的25例非小细胞肺癌患者(肺腺癌20例、肺鳞癌5例)中有12例患者自愿进行EGFR基因突变检测,EGFR基因突变率为41.67%,其中肺腺癌中EGFR基因突变主要为外显子21点突变。结论 EBUS-TBNA结合免疫组化诊断老年肺癌具有较高的应用价值,且通过EGFR基因检测获得了精准的基因突变信息,有助于NSCLC患者后续的个体化、规范化的分子靶向治疗。
[Abstract]:Objective to evaluate the role of transbronchial needle aspiration biopsy (EBUS-TBNA) combined with immunohistochemistry in the diagnosis of elderly lung cancer, and to detect the epidermal growth factor (EGFR) gene mutation in patients with non-small cell lung cancer (NSCLC) diagnosed by EBUS-TBNA. In order to achieve a reasonable follow-up individualized targeted therapy. Methods Sixty-one elderly patients with mediastinal or hilar lymphadenopathy or intrathoracic mass were examined by chest CT. EBUS-TNA combined with immunohistochemical examination was performed. Complications and patient satisfaction were studied. EGFR gene mutation was detected in EBUS-TBNA diagnosed NSCLC patients and the differences of EGFR gene mutation among different types of non-small cell lung cancer were analyzed. Results among the 90 puncture sites in 61 elderly patients, the positive rate of EBUS-TNA immunohistochemical staining was significantly higher than that of 94.44%vs (94.44%vs 82.22, 蠂 2. 523 P0. 011), 58 cases were confirmed by EBUS-TBNA, and 58 cases were confirmed by EBUS-TBNA, and the positive rate of EBUS-TBNA was significantly higher than that of routine pathological examination (94.44%vs 82.22, 蠂 2, 6.523, P0. 011), and 58 cases were confirmed by EBUS-TBNA. The accuracy, sensitivity and specificity of diagnosis of lung cancer were 95.08, 94.29 and 100, respectively. In 35 elderly patients with lung cancer, the positive rate of routine pathological immunohistochemical examination was higher than that of routine pathological detection, but the difference was only statistically significant in lung adenocarcinoma cases (蠂 2 / 24.286 / P 0.038) and EBUS-TBNA diagnosis of lung cancer. Only 7 patients (11.48%) had minor complications. All patients showed good satisfaction with anesthesia, operation and 24 hours after operation. Among the 25 patients with non-small cell lung cancer diagnosed by EBUS-TBNA, 12 patients (20 cases of adenocarcinoma of lung and 5 cases of squamous cell carcinoma of lung) volunteered to detect EGFR gene mutation. The mutation rate of EGFR gene in lung adenocarcinoma was 41.67%. The main mutation of EGFR gene in lung adenocarcinoma was 21:00 mutation in exon. Conclusion EBUS-TBNA combined with immunohistochemistry is of great value in the diagnosis of elderly lung cancer, and the accurate information of gene mutation can be obtained by EGFR gene detection, which is helpful for individualized and standardized molecular targeted therapy in patients with NSCLC.
【作者单位】：遵义医学院第一附属医院呼吸二科;
【基金】：贵州省科技厅资助项目(黔科合LH字[2016]7473号)
【分类号】：R734.2

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