Objective: To evaluate the diagnostic value of thin-slice CT navigation combined with cytology in routine preoperative bronchoscopy of peripheral pulmonary lesions and compare the diagnostic effects of different cytological sampling methods. Methods: The clinical data of peripheral lung cancer patients with preoperative bronchoscopy and cytology sampling guided by thin-slice CT from May 2015 to July 2016 in Cancer Hospital, Chinese Academy of Medical Sciences were retrospectively analyzed. The diagnostic accuracy, sensitivity and specificity of different cytological sampling methods for peripheral pulmonary lesions guided by thin-slice CT were compared, the factors affected the diagnostic sensitivity were analyzed, and the complications induced by these methods were observed. Results: The diagnostic sensitivity of thin-slice CT navigation combined with bronchoalveolar lavage for peripheral pulmonary lesions was 39.1%, and the positive diagnosis rate was 35.1%. The diagnostic sensitivity of thin-slice CT navigation combined with cell brush for peripheral pulmonary lesions was 51.7%, and the positive diagnosis rate was 46.4%. The diagnostic sensitivity of bronchoalveolar lavage combined with cell brush for peripheral pulmonary lesions was 57.5%, and the positive diagnosis rate was 51.5%. The positive diagnosis rate between brush sampling and bronchoalveolar lavage was statistically different (P=0.01). No significant difference was observed in the diagnostic rate between cell brush and cell brush combined with bronchoalveolar lavage (P=0.06). The factors affected diagnostic sensitivity of brush included the lesion location, size, and the relationship between the lesion and bronchial (all P<0.05). When the size of the peripheral lung lesion >2 cm, the diagnostic sensitivity of thin-slice CT navigation combined with cell brush for peripheral pulmonary lesions was 73.6%. Its positive diagnosis rate was 68% and the specificity was 100%, respectively. Two cases of mild bleeding were observed, and hemorrhage was terminated by conservative treatment. Conclusion: Preoperative thin-slice CT navigation combined with cytological examination is an effective method for the diagnosis of peripheral pulmonary lesions, and the diagnostic efficiency of cell brush is higher than that of bronchoalveolar lavage, especially for the lesion size >2 cm.
目的： 探讨薄层CT导航联合细胞学在周围型肺癌术前常规支气管镜检查中的价值，比较不同细胞学取样方法的诊断效能。 方法： 对胸部薄层CT提示存在周围型肺部病变的97例患者的97个病灶，术前在薄层CT导航下，通过支气管镜行肺泡灌洗和细胞刷取样送细胞学诊断。计算薄层CT导航下不同细胞学取样方法对周围型肺癌的诊断阳性率、灵敏度和特异度，分析诊断阳性率的影响因素和并发症发生情况。 结果： 薄层CT导航下，支气管肺泡灌洗诊断阳性34例，诊断阳性率为35.1%，灵敏度为39.1%；细胞刷取样诊断阳性45例，诊断阳性率为46.4%，灵敏度为51.7%；支气管肺泡灌洗联合细胞刷取样诊断阳性50例，诊断阳性率为51.5%，灵敏度为57.5%。细胞刷取样与支气管肺泡灌洗诊断阳性率差异有统计学意义(P＝0.01)，而细胞刷取样与细胞刷联合支气管肺泡灌洗诊断阳性率差异无统计学意义(P＝0.06)。薄层CT导航联合细胞刷取样诊断周围型肺癌的阳性率与病变所在支气管级数、病变与支气管的关系、病灶长径有关(均P<0.05)。当病灶长径>2 cm时，薄层CT导航联合细胞刷取样诊断周围型肺癌的阳性率为68.0%，灵敏度为73.6%，特异度为100%。97例患者中2例患者有少量出血。 结论： 周围型肺癌患者术前常规支气管镜检查，应用薄层CT导航联合细胞学具有一定的诊断价值，细胞刷取样诊断阳性率优于支气管肺泡灌洗。尤其是对2 cm以上病灶，薄层CT导航联合细胞刷取样可达到较高的诊断阳性率。.
Keywords: Bronchoalveolar lavage; Bronchoscopy; Cytology; Peripheral lung carcinoma; Thin-slice computed tomography.