细胞DNA定量分析在脱落细胞学诊断中的应用

Celluar DNA quantitative analysis in cytology for clincal application in diagnosis

目的探讨自动细胞DNA定量分析系统在良恶性胸水、腹水、心包积液及乳腺包块诊断中的价值。方法 297例浆膜腔积液(胸水185例、腹水94例、心包积液18例),经细胞采集器处理,每例制成4张薄层细胞片,2张细胞片做巴氏染色,用于常规细胞学检查。另2张经Feulgen染色,用自动细胞DNA定量分析系统检测。122例乳腺包块住院患者,诊断医师进行针吸穿刺后每例制成2张薄层涂片,1张涂片做巴氏染色,用于常规细胞学检查。另1张经Feulgen染色,用自动细胞DNA定量分析系统检测。每例均有病理结果证实。结果 297例浆膜腔积液标本常规检测138例(44.5%)异常,而同样的标本中DNA定量检测131例(44.1%)异常。常规细胞学诊断为癌及可疑癌细胞84例中100%出现异倍体细胞,常规诊断为找到异型细胞的54中有47例(87%)出现异倍体细胞。122例乳腺肿物经病理证实,41例为乳腺良性肿瘤8,1例为恶性。常规细胞学方法对良恶性乳腺包块的诊断阳性率分别为92.7%、91.4%,AICM的诊断阳性率分别为100%、90.1%。结论应用自动细胞DNA定量分析系统可弥补常规形态学工作的不足,二者协同诊断,可发现早期癌变的细胞,提高诊断率,为临床制定治疗方案提供有价值的信息,使细胞学检查工作更完善、客观。

Purpose To differentially diagnose the benign and malignant,peritioneal effusions,pericarditis effusions and breast masses by using automatic imaging cytometer.Methods In 297 samples of serous effusions,including 185 samples of hydrothorax,94 peritioneal effusions,18 pericarditis effusions） were processed with a cell collectioner,4 slides were prepared for each sample：2 sliders were stained by Papanicolaou method for cytology analysis,and other 2 sliders were stained with Feulgen method for DNA imaging cytometer.In 122 patients with breast masses,2 smears were prepared by fine-needle aspiration puncture for each patient： 1 for Papanicolaou stain for cytology analysis,and other 1 for Feulgen stain for DNA imaging cytometer.Pathological results were confirmed in each case.Results In 297 samples of serous effusion,138（44.5%） were abnormal by cytology analysis,and 131（44.1%） were abnormal by DNA imaging cytometer.By cytology analysis 84 were found as cancer cells and dubious cells,and 100% were found heteroploid cells.By cytology analysis 54 were found a few proliferating cells,and 47（87%） were found heteroploid cells.In the pathologically confirmed breast masses,41 were classified as benign and other 81 as malignant.Cytological investigation showed 92.7% sensitivity for benign and 91.4% sensitivity for malignant,while DNA imaging analysis revealed 100% sensitivity for benign and 90.1% sensitivity for malignant.Conclusions The automatic imaging cytometer can remedy insufficiency of routine cytology,and collaboration of the two methods could improve the diagnostic rate of breast cancer,which provides valuable information for clinical manegement and makes cytology analysis more perfective and objective.