窄带成像支气管镜对肺癌组织学类型诊断价值(1)

http://www.100md.com 2019年4月2日 《医学信息》 2019年第13期

     摘要：目的 探討窄带成像(NBI)支气管镜下病理血管影像与肺癌组织学的关系。方法 收集我院2017年10月～2019年2月收治的165例行支气管镜检查并确诊肺癌患者，根据NBI支气管镜图像来确定主要的病理血管类型(星点状，扭曲、增粗，突然中断的血管)，分析NBI下不同病理学管类型和肺癌组织分型，比较NBI诊断的敏感度、特异度和阳性预测值(PPV)、阴性预测值(NPV)。结果 NBI下出现星点状血管影患者中腺癌占70.45%、鳞癌11.36%、小细胞癌18.18%，对肺腺癌诊断的敏感度、特异度、PPV、NPV分别为81.57%、89.76%、0.705、0.942;血管走形扭曲增粗患者中鳞癌81.54%、腺癌4.62%、小细胞癌10.77%、低分化癌3.08%，对鳞癌诊断的敏感度、特异度、PPV、NPV分别为58.89%、84.00%、0.815、0.630。血管走形突然中断患者中鳞癌57.14%、小细胞癌30.36%、腺癌7.14%;星点状血管类型下，腺癌较鳞癌和小细胞癌多，差异有统计学意义(P<0.05);血管走形扭曲、增粗类型，鳞癌较腺癌、小细胞癌多，差异有统计学意义(P<0.05);血管走形突然中断类型中鳞癌和腺癌少于小细胞癌，差异有统计学意义(P<0.05)。结论 NBI支气管镜有助于镜下对腺癌、鳞癌同其他类型肺癌的快速鉴别及镜下肺癌病理类型初步推断。

    关键词：窄带成像;肺癌;支气管镜

    中图分类号：R734.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2019.13.021

    文章编号：1006-1959(2019)13-0077-04

    Abstract：Objective To investigate the relationship between pathological vascular imaging and lung cancer histology in narrow-band imaging (NBI) bronchoscopy. Methods A total of 165 patients who underwent bronchoscopy and confirmed lung cancer in our hospital from October 2017 to February 2019 were enrolled. According to NBI bronchoscopy images， the main pathological blood vessel types (star-shaped， twisted， thickened， and suddenly interrupted) were determined. The blood vessels were analyzed for different pathological tube types and lung cancer tissue types under NBI， and the sensitivity， specificity， positive predictive value (PPV)， and negative predictive value (NPV) of NBI diagnosis were compared. Results Among the patients with star-shaped vascular shadows under NBI， adenocarcinoma accounted for 70.45%， squamous cell carcinoma 11.36%， and small cell carcinoma 18.18%. The sensitivity， specificity， PPV and NPV of lung adenocarcinoma were 81.57% and 89.76%， respectively. 0.705， 0.942; squamous cell carcinoma with 81.54%， adenocarcinoma 4.62%， small cell carcinoma 10.77%， and poorly differentiated carcinoma 3.08%， the sensitivity， specificity， PPV and NPV of squamous cell carcinoma were 58.89%， 84.00%， 0.815， 0.630. The vascular stenosis suddenly interrupted 57.14% of squamous cell carcinoma， 30.36% of small cell carcinoma， and 7.14% of adenocarcinoma. Under the stellate vascular type， adenocarcinoma was more than squamous cell carcinoma and small cell carcinoma(P<0.05); vascular shape distortion， thickening type， squamous cell carcinoma compared with adenocarcinoma， small cell carcinoma(P<0.05); vascular squamous abrupt discontinuation type squamous cell carcinoma and adenocarcinoma less than small cell carcinoma(P<0.05). Conclusion NBI bronchoscopy is helpful for the rapid identification of adenocarcinoma， squamous cell carcinoma and other types of lung cancer and the preliminary inference of pathological types of lung cancer.(段建民 蒋萍 刘莉)

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