肝脏肿块针吸组织学和细胞学诊断及AgNOR分析

Cytological Diagnosis and AgNOR Analysis in Aspiration of the Liver Neoplasm

对４２例临床病理资料齐全的肝脏肿块针吸切片、涂片和涂片ＡｇＮＯＲ颗粒进行分析。切片为正常肝细胞４例、肝细胞异型７例、恶性肿瘤３１例。ＨＥ涂片与切片诊断符合率，在良性为１００％（１１／１１）例，恶性为８７％（２７／３１例）。３组涂片ＡｇＮＯＲ颗粒计数各为１.６４±０.７４、４.５２±１.２０和８.５３±１.８７，３组间差异非常显著Ｐ＜０.０１。以７个颗粒做良恶性分界，ＡｇＮＯＲ校正涂片诊断后，恶性符合率可达９７％（３０／３１例）。提议使用ＨＥ涂片定位脱色复染ＡｇＮＯＲ，严格选定被计数的细胞，对涂片误诊原因作了分析。

Aspiration smear samples from 42 cases of liver neoplasmguided by B-ultrasonography were studied and compared with AgNOR analysis.of the smears of liver cancer no cancer cells were seen in 4,in 7 cases dysplastic livercells were observed and malignant cells found in the other 31 cases.The aspirationsmear cytology yielded diagnosis in agreement witn tile histological diagnosis forbenign lesions in 100%(11/11)and 87%(27/31)for malignancies.The 4 cases thathad been erroneously diagnosed as normal were attributed to scanty tumor cells andlack of confidence.The number of AgNOR particles in the smear samples was1.64±0.47SD)in NC(no cancer cell),4.52±1. 20 in DC(dysplastic cell) and 8.53±1.87 inMT(malignant tumor)with significant statistical difference(P<0.01).Setting 7particles as threshold standard for malignancy the 3 misdiagnosed as benign lesionand 3 doubtful cases each of which contained AgNOR counts of 6.68,6.76,6.80,6.94,8.92,9.orespectively,can be categorized as malignant.Consequently,the diagnositic accuracy would be elevated from 87% to 97%(30/31).The AgNOR particles varied in type with different cells. in cells of hepatocarcinoma they were of the coagulative type,in cells of metastatic adenocarcinoma they were of scattering type primarily,while in metastatic malignant fibrous histiocytoma cell they were of mixed type.The tumor and type of AgNOR particle not only help to distinguish benignfrom malignant cell but also is useful to identify the origin of the cell during smearexamination of liver tumor aspiration sample.