作者：王妍,石芳,刘俊霞,颜晶晶

单位：

1.065201 河北省三河市，河北医科大学附属燕达医院呼吸与危重症医学科 2.065000 河北省廊坊市，河北中石油中心医院呼吸 与危重症医学科 通信作者：颜晶晶，E-mail：yanjing850103@163.com

Units：

1.Department of Respiratory and Critical Care Medicine, Yanda Hospital Affiliated to Hebei Medical University, Sanhe065201, China 2.Department of Respiratory and Critical Care Medicine, Hebei Petro China Center Hospital, Langfang 065000, China Corresponding author: YAN Jingjing, E-mail: yanjing850103@163.com

关键词：

肺肿瘤; 支气管镜; 经支气管镜针吸活检术; 分子标志物; 病理分型;

Keywords：

Lung neoplasms; Bronchoscopes; Transbronchial needle aspiration; Molecular markers; Pathologicalclassification

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.275

Funds：

河北省廊坊市科学技术研究与发展计划自筹经费项目（2017013046）

摘要：

背景纤维支气管镜检查已在临床应用近50年,其镜下视野可达到次小叶支气管,实现直视下活检及活检后吸引等操作。目前,随着支气管镜技术的发展与设备的完善,自动荧光支气管镜等新技术的出现较好地弥补了传统支气管镜检查的不足,并且可较为精确地评估肺癌分型。目的 分析经支气管镜针吸活检术在肺癌术前病理分型中的应用价值。方法 回顾性选取2017年10月至2020年10月在河北医科大学附属燕达医院、河北中石油中心医院进行手术治疗的肺癌患者180例为研究对象,按照术后病理组织活检结果将其分为腺癌(AC)组(n=82)、鳞状细胞癌(SCC)组(n=58)及小细胞肺癌(SCLC)组(n=40)。所有患者术前采用经支气管镜针吸活检术取病理组织,然后采用实时聚合酶链式反应(PCR)检测分子标志物〔甲状腺转录因子1(TTF-1)、Napsin A、细胞角蛋白5(CK5)、细胞角蛋白7(CK7)、P40、P63、Ki67〕表达水平。比较三组患者分子标志物表达水平。以术后病理组织活检结果为“金标准”,分析TTF-1、Napsin A及CK7联合检测诊断AC的价值,CK5、P40及P63联合检测诊断SCC的价值,TTF-1、P40及Ki67联合检测诊断SCLC的价值。记录患者经支气管镜针吸活检术后并发症发生情况。结果 SCC组患者TTF-1、Napsin A、CK7表达水平低于AC组,CK5、P40、P63表达水平高于AC组(P <0.05);SCLC组患者TTF-1、Napsin A、CK7表达水平低于AC组,P40、Ki67表达水平高于AC组(P <0.05);SCLC组患者TTF-1、Ki67表达水平高于SCC组,CK5、P40、P63表达水平低于SCC组(P <0.05)。TTF-1、Napsin A及CK7联合检测诊断AC的正确率为0.872,灵敏度为0.866,特异度为0.878,Kappa值为0.743。CK5、P40及P63联合检测诊断SCC的正确率为0.878,灵敏度为0.879,特异度为0.877,Kappa值为0.730。TTF-1、P40及Ki67联合检测诊断SCLC的正确率为0.889,特异度为0.914,灵敏度为0.800,Kappa值为0.859。患者经支气管镜针吸活检术后发生的并发症主要包括气胸、出血和感染,总并发症发生率为13.3%(24/180);经治疗后患者均恢复良好。结论 经支气管镜针吸活检术在肺癌术前病理分型中有较好的应用价值,且安全性良好,值得临床推广。其中TTF-1、Napsin A及CK7联合检测可有效诊断AC,CK5、P40及P63联合检测可有效诊断SCC,TTF-1、P40及Ki67联合检测可有效诊断SCLC。

Abstract：

【Abstract】　Background Fiberoptic bronchoscopy has been used in clinical practice for nearly 50 years, and itsfield of vision can reach the sublobular bronchus, and it can realize direct vision biopsy and post-biopsy suction. At present,with the development of bronchoscopy technology and the improvement of equipment, the emergence of new technologies such asautomatic fluorescent bronchoscopy has made up for the shortcomings of traditional bronchoscopy, and can accurately evaluatethe classification of lung cancer. Objective To analyze the application value of transbronchial needle aspiration in preoperativepathological classification of lung cancer. Methods A total of 180 patients with lung cancer who underwent surgical treatmentin Yanda Hospital Affiliated to Hebei Medical University and Hebei Petro China Center Hospital from October 2017 to October2020 were retrospectively selected as the research objects. They were divided into adenocarcinoma (AC) group (n=82) , squamouscell carcinoma (SCC) group (n=58) and small cell lung cancer (SCLC) group (n=40) according to the results of postoperativehistopathological biopsy. All patients underwent preoperative transbronchial needle aspiration for pathological tissue. Then realtime polymerase chain reaction (PCR) was used to detect the expression levels of molecular markers [thyroid transcription factor 1(TTF-1) , Napsin A, cytokeratin 5 (CK5) , cytokeratin 7 (CK7) , P40, P63, Ki67] . The expression levels of molecular markers werecompared among the three groups. With the results of postoperative pathological tissue biopsy as the "gold standard" , the value ofcombined detection of TTF-1, Napsin A and CK7 in the diagnosis of AC, the value of combined detection of CK5, P40 and P63 inthe diagnosis of SCC, and the value of combined detection of TTF-1, P40 and Ki67 in the diagnosis of SCLC were analyzed. Thecomplications after transbronchial needle aspiration were recorded. Results The expression levels of TTF-1, Napsin A and CK7in SCC group were lower than those in AC group, while the expression levels of CK5, P40 and P63 were higher than those in ACgroup (P < 0.05) . The expression levels of TTF-1, Napsin A and CK7 in SCLC group were lower than those in AC group, whilethe expression levels of P40 and Ki67 were higher than those in AC group (P < 0.05) . The expression levels of TTF-1 and Ki67in SCLC group were higher than those in SCC group, while the expression levels of CK5, P40 and P63 were lower than those inSCC group (P < 0.05) . The accuracy rate, sensitivity, specificity and Kappa value of combined detection of TTF-1, Napsin A andCK7 for diagnosing AC were 0.872, 0.866, 0.878 and 0.743, respectively. The accuracy, sensitivity, specificity andKappa valueof combined detection of CK5, P40 and P63 for diagnosing SCC were 0.878, 0.879, 0.877 and 0.730, respectively. The accuracyrate, specificity, sensitivity and Kappa value of combined detection of TTF-1, P40 and Ki67 for diagnosing SCLC were 0.889,0.914, 0.800 and 0.859, respectively. The complications after bronchoscopic needle aspiration mainly included pneumothorax,bleeding and infection, with a total complication rate of 13.3% (24/180) . All patients recovered well after treatment.Conclusion Transtransbronchial needle aspiration has a good application value in preoperative pathological classificationevaluation of lung cancer, with good safety and it is worthy of clinical promotion. The combined detection of TTF-1, Napsin A andCK7 can effectively diagnose AC, the combined detection of CK5, P40 and P63 can effectively diagnose SCC, and the combineddetection of TTF-1, P40 and Ki67 can effectively diagnose SCLC.

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