胸水中肺腺癌细胞DNA定量检测的临床病理学意义

Clinicopathological significance of DNA-image cytometry for detecting adenocarcinoma in pleural effusion

目的探讨DNA定量检测在胸水肺癌细胞病理学诊断中的应用价值,并为肺癌伴胸水病例选择性扩大手术指征提供依据。方法我院临床诊断为肺癌伴胸水的患者50例,制备常规胸水涂片,进行改良FeulgenDNA染色,应用2000型癌细胞定量检测系统测定DNA主峰质量、平均DNA质量、DNA指数(DI)、DNA倍体类型和细胞周期等参数。结果本组患者病理学诊断均为腺癌,78%(39/50例)在胸水中找到癌细胞,其中8例原先诊断为核异型,通过DNA测定确诊,阳性率提高16%。常规细胞病理阳性率为62%,灵敏度为79.5%,特异度为100%;DNA定量检测阳性率为78%,灵敏度及特异度均为100%(χ2=6.13,P<0.05)。癌细胞阳性组平均DNA质量为(18.29±1.48)pg,DI为1.45±0.35,5倍体超过率为(6.00±10.54)%;癌细胞阴性组平均DNA质量为(7.03±1.75)pg,DI为0.83±0.15,5倍体超过率为(0.12±0.29)%;两组的差异均有显著性(P<0.05)。结论胸水细胞DNA检测有助于提高肺癌细胞病理学阳性率,可为渗出性胸水(无癌细胞)的病例选择性扩大手术指征提供依据。

Objective To appraise the clinicopathologic significance of DNAimage cytometry data for detecting lung cancer cells in pleural effusion. Methods Conventional smears stained with reformedFeulgen reaction from fifty cases of pleural effusion in lung adenocarcinomas were investigated for several DNAimage cytometry data. Results Adenocarcinoma cells were found in 78% (39/50) cases, 8 cases formerly diagnosed as anaplasia were verified as adenocarcinoma after analysing the DNAimage cytometry data. The positive rate was raised 16%. The positive rate 62%, sensitivity 79.5% and specificity 100% revealed the detection ability of malignant cells in conventional cytology. The positive rate 78%, sensitivity 100% and specificity 100% showed the possibility of identificating malignant cells in DNA image cytometry (χ2=6.13,P<0.05). DNAimage cytometry data in carcinomapositive group showed as follows: averaging DNA mass (18.29±1.48) pg, DI=1.45±0.35 and DNAaneuploidy more than 5 (6.00±10.54)%. DNAimage cytometry data in the carcinomanegative group demonstrated: average DNA mass about (7.03±1.75) pg, DI=0.83±0.15 and DNAaneuploidy more than 5 (0.12±0.29)%. There were significant differences between the two groups (P<0.05). Conclusions DNA image cytometry in pleural effusion is helpful in raising the positive rate of cytopathological diagnosis in adenocarcinoma of lung and provides evidences for operation of cases with tumor cell free pleural effusion.