PULMONARY MICROVASCULAR CYTOLOGY IN THE DIAGNOSIS OF LYMPHANGITIC CARCINOMATOSIS
PULMONARY MICROVASCULAR CYTOLOGY IN THE DIAGNOSIS OF LYMPHANGITIC CARCINOMATOSIS
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DOI：
10.1056/nejm198907133210202
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发表时间：
1989-07-13
影响因子：
158.5
通讯作者：
MCGRATH, J
中科院分区：
文献类型：
--
作者：
MASSON, RG;KRIKORIAN, J;MCGRATH, J
肺部癌淋巴管扩散的诊断有时很困难。我们研究了通过楔形肺动脉导管从八名患者身上抽取的血液的细胞学特征，这些患者通过随后的尸检、肺活检或临床评估证实患有癌性淋巴管病。原发肿瘤的部位是前列腺、乳腺、食道和肺。八名患者中有七名发现了恶性肿瘤细胞。 17 名癌症患者中，有 16 名无肺转移，而 23 名非恶性肺部疾病患者中，有 22 名细胞学结果正常。在一名患有肺部肿瘤栓塞的癌症患者中，结果呈阳性，可能是因为大肝静脉中存在广泛的血管内肿瘤。一名患有广泛性肺梗塞的患者出现了一项假阳性结果。巨核细胞大量存在于肺毛细血管床中，是用于肺微血管细胞学研究的令人满意的肺血管血样的标志。熟悉巴氏制剂中这些细胞的细胞学特征对于避免错误地将其识别为恶性细胞至关重要。尽管经支气管肺活检仍然是这种疾病的首选诊断程序，但我们的研究结果表明，癌症患者肺微血管细胞学标本中存在恶性细胞并伴有不明原因的呼吸困难，构成癌性淋巴管病的推定证据。当肺活检被拒绝或被认为太危险时，肺微血管细胞学检查可能特别有价值。
The diagnosis of lymphangitic spread of carcinoma in the lungs is sometimes difficult. We studied the cytologic characteristics of blood drawn through a wedged pulmonary-artery catheter from eight patients in whom lymphangitic carcinomatosis was confirmed by subsequent autopsy, lung biopsy, or clinical evaluation. The sites of the primary tumors were the prostate, breast, esophagus, and lung. Malignant cells were found in seven of the eight patients. Cytologic findings were normal in 16 of 17 patients with cancer but without pulmonary metastases and in 22 of 23 patients with nonmalignant pulmonary disorders. In a patient with cancer with tumor embolism to the lungs, the findings were positive, probably because of extensive intravascular tumor in large hepatic veins. One false positive finding occurred in a patient with extensive pulmonary infarction. Megakaryocytes, which are present in large numbers in the pulmonary capillary bed, are the hallmark of a satisfactory pulmonary vascular blood sample for pulmonary microvascular cytologic study. Familiarity with the cytologic characteristics of these cells in Papanicolaou preparations is essential to avoid mistakenly identifying them as malignant. Although transbronchial lung biopsy remains the diagnostic procedure of choice in this disorder, our findings suggest that the presence of malignant cells in pulmonary microvascular-cytology preparations in patients with cancer and unexplained dyspnea constitutes presumptive evidence of lymphangitic carcinomatosis. Pulmonary microvascular cytology may be particularly valuable when lung biopsy is refused or is thought to be too hazardous.