细胞蜡块结合免疫组化有效提高胸水细胞学阳性检出率的临床研究

Application of paraffin imbedded cell blocks technology combined with immunohistochemistry for effectively improving the positive rate of pleural effusion cytology

目的:探讨细胞蜡块结合免疫组化技术在提高肺癌胸水细胞学阳性检出率及提供分型诊断方面的应用价值。方法:收集252例胸水样本,分别行沉降式薄层液基细胞学和细胞蜡块制片,比较两种方法在胸水阳性检出率方面的差异性。对于细胞蜡块诊断为阳性和可疑阳性的病例进一步行TTF-1、CK7、CK5/6、p63、Calretinin、WT-1、Syn、Cg A、Ki-67等免疫组化染色以分型。对于58例同时有活检结果的病例,以活检病理诊断结果为金标准,评价细胞蜡块结合免疫组化在分型诊断中的准确性。结果:252例胸水样本中,液基细胞学和细胞蜡块的阳性检出例数(率)分别为72例(28.6%)及125例(49.6%),二者差异具有显著性(P<0.01)。58例经组织学确诊的病例中,有56例与细胞蜡块结合免疫组化法分型的结果相一致(56/58,96.6%)。结论:细胞蜡块制片技术可显著提高胸水阳性检出率。细胞蜡块结合免疫组化技术在胸水标本组织学分型方面具有良好的应用性。

Objective： The paraffin imbedded cell blocks combined with immunohistochemistry were used to improve the positive rate of pleural effusion cytology and provide more information for histological classification. Methods： All 252 cases of pleural effusion were used for thinprep cytology test and paraffin imbedded cell blocks technique. The difference of the two methods in pleural effusion positive rate was analyzed after hematoxylin and eosin staining（ HE）. TTF- 1,CK7,CK5 /6,p63,Calretinin,WT- 1,Syn,Cg A and Ki- 67 were detected by immunohistochemistry（ IHC） method for histological classification. Among 58 cases of paraffin imbedded cell blocks which had correspondent biopsy result,the clinical value of paraffin imbedded cell blocks of pleural effusion for diagnostic classification was evaluated compared with the biopsy diagnostic results. Results： The positive rate of paraffin imbedded cell blocks（ 49. 6%） was significantly higher than that of thinprep cytology test（ 28. 6%） among 252 cases of pleural effusion（ 125 vs 72,P 0. 01）. The histological classification results of 56 paraffin imbedded cell blocks were consistent with their correspondent biopsy specimens（ 56 /58,96. 6%）. Conclusion： Paraffin imbedded cell blocks technology can significantly improve the positive rate of pleural effusion cytology. Combination of paraffin imbedded cell blocks technology with immunocytochemistry has great application value in terms of the histological classification.