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中华介入放射学电子杂志 ›› 2021, Vol. 09 ›› Issue (03) : 307 -312. doi: 10.3877/cma.j.issn.2095-5782.2021.03.012

非血管介入

快速现场评估（ROSE）在胸部肿瘤气管镜介入诊断中的应用价值
王丽伟1, 李银2,†(), 万良红2, 黄云超3, 谭慧3, 胡早秀4, 黄秋博3, 田民5   
  1. 1. 650118　云南昆明，昆明医科大学第三附属医院（云南省肿瘤医院）超声医学科
    2. 655500　云南曲靖，富源县人民医院（昆明医科大学第三附属医院联盟医院）胸外（肿瘤）科
    3. 650118　云南昆明，昆明医科大学第三附属医院（云南省肿瘤医院）胸外科一病区
    4. 650118　云南昆明，昆明医科大学第三附属医院病理科
    5. 650051　云南昆明，昆明市延安医院血管外科
  • 收稿日期:2020-12-19 出版日期:2021-08-25
  • 通信作者: 李银

The value of rapid on-site evaluation applied in the bronchoscopic intervention for diagnosis of thoracic neoplasms

Liwei Wang1, Yin Li2,†(), Lianghong Wan2, Yunchao Huang3, Hui Tan3, Zaoxiu Hu4, Qiubo Huang3, Min Tian5   

  1. 1. Department of Ultrasound Medicine, the Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Yunnan Kunming 650118
    2. Thoracic Surgery and Tumor Department, Fuyuan County People's Hospital (the Third Affiliated Hospital of Kunming Medical University Union Hospital), Yunnan Qujing 655000
    3. Department of Thoracic Surgery I, the Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Yunnan Kunming 650118
    4. Pathology Department, the Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital, Yunnan Cancer Center), Yunnan Kunming 650118
    5. Department of Vascular Surgery, Yanan Hospital of Kunming City, Yunnan Kunming 650051, China
  • Received:2020-12-19 Published:2021-08-25
  • Corresponding author: Yin Li
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王丽伟, 李银, 万良红, 黄云超, 谭慧, 胡早秀, 黄秋博, 田民. 快速现场评估（ROSE）在胸部肿瘤气管镜介入诊断中的应用价值[J]. 中华介入放射学电子杂志, 2021, 09(03): 307-312.

Liwei Wang, Yin Li, Lianghong Wan, Yunchao Huang, Hui Tan, Zaoxiu Hu, Qiubo Huang, Min Tian. The value of rapid on-site evaluation applied in the bronchoscopic intervention for diagnosis of thoracic neoplasms[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(03): 307-312.

目的

探讨快速现场评估（ROSE）在胸部肿瘤支气管活检中的应用价值及安全性分析。

方法

回顾性分析云南省肿瘤医院2019年10月—2020年10月间635例行支气管内镜检查联合快速现场评估胸部肿瘤患者的临床资料，全组患者均为CT或PET/CT确认存在肺部占位性病变、至少1组纵隔或肺门淋巴结肿大。

结果

全组患者均顺利完成活检操作，并发症发生率14.9%（95/635），无严重并发症；全组ROSE诊断与HE染色诊断一致性93.7%（594/635），确诊恶性485例中，ROSE诊断假阴性率2.4%（15/635），未出现假阳性结果；全组肺肿物共取材680部位，共1 785次取材，平均取材数（2.6 ± 1.9）次，取材成功率89.3%（1 588/1 785）；纵隔淋巴结穿刺435处，共865针，平均穿刺数（2.0 ± 0.4）次，穿刺成功率82.1%（710/865）。70例首次非ROSE检查HE结果为可疑恶性患者，行ROSE检查评估最终11例确诊为恶性，有效率78.5%（55/70）。

结论

快速现场评估技术运用于胸部肿瘤支气管活检诊断，取材成功率高、与HE染色一致性好，可有效降低二次检查率，操作简便、安全可靠、值得临床推广。

关键词: 快速现场评估, 胸部肿瘤, 气管镜介入诊断
Objective

To explored the value and safety of rapid on-site evaluation (ROSE) applied in bronchoscopic intervention for diagnosis of thoracic neoplasms.

Methods

The clinical data of 635 patients with thoracic neoplasms underwent bronchoscopic intervention diagnosis and ROSE in the Yunnan Tumor Hospital from October 2019 to October 2020 were retrospectively analyzed. All patients were confirmed by CT or PET/CT with pulmonary lesions or at least 1 set of mediastinal or hilar lymph nodes enlargement.

Results

All patients successfully completed the biopsy operation. The complication rates were 14.9% (96/635), and there were no serious complications. The coherence of ROSE and HE staining was 93.7% (594/635). Among 485 cases of malignant diagnosis, the false negative rate of ROSE was 2.4% (15/635), and there were no false positive results. The whole group of lung neoplasms were performed 1 785 times biopsies at 680 sites, withan average of (2.6 ± 1.9) per site. The successful rate of biopsies was 89.3% (319/357). Mediastinal lymph nodes were punctured at 435 sites for 865 times with an average of (2.0 ± 0.4) punctures per site. The successful rate was 82.1% (710/865). Among 70 patients with suspected malignant by HE staining in the first non-ROSE examination, 55 cases got confirmed malignant diagnoses by ROSE examination, and the effective rate was 78.5% (55/70).

Conclusions

ROSE applied in the bronchoscopic intervention for diagnosis of thoracic neoplasms has good concordance with HE staining in the diagnosis. ROSE has a high biopsy success rate, could effectively reduce the recheck rate, and is easy to operate, safe and reliable. ROSE is worthy of clinical application.

Key words: Rapid on-site evaluation, Thoracic neoplasms, Bronchoscopic intervention diagnosis
图1 细胞（10 × 20）呈大小不一腺样结构，可见散在核仁（腺癌）
图2 细胞（10 × 20）形态不规则，呈裸核拉丝样改变（小细胞肺癌）
图3 重叠细胞（10 × 20）多，结构不清，背景见散在分布血红细胞
图4 重叠细胞（10 × 20）重叠，结构模糊，背景见血红细胞
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