乳头湿疹样病变74例刮片细胞病理学检查分析

Cytopathological scrape examination of eczema-like lesions of nipple

目的探讨乳头湿疹样病变的刮片细胞病理学检查的可靠性、实用性和局限性。方法使用载玻片对74例乳头皮肤湿疹样病变刮取样本涂片后做出细胞学诊断,其中61例获得组织病理学核对,并对其余13例进行3年以上随访。结果①在56例乳头湿疹样癌(Paget病)中,细胞学诊断恶性51例、可疑恶性4例及阴性1例。②在3例乳头腺瘤中,细胞刮片诊断为良性瘤样病变2例,可疑恶性1例。③在3例乳头单纯疱疹病毒感染的细胞刮片中全部发现病毒包涵体并且做出明确诊断,经3年以上随访痊愈后均未发生肿瘤。④12例乳头慢性炎性病变细胞学诊断为阴性,2例经组织学活检证实,经3年以上随访均未发现有肿瘤。⑤诊断恶性肿瘤的敏感度98.2%(55/56),诊断良性病变的特异度94.4%(17/18),诊断总准确率97.3%(72/74);假阴性率为1.8%(1/56),潜在假阳性率为5.6%(1/18),总误诊率为2.7%(2/74)。结论在乳头湿疹样病变细胞病理学检查中,采用载玻片刮片法具有操作简便、安全、取样充足、诊断准确率高及应用范围广等优点;但存在一定的局限性,特别是对具有导管上皮细胞非典型增生的病变需要通过组织病理学诊断鉴别。

Objective To investigate the reliability,practicability and limitations of cytopathological scrape examination in the diagnosis of eczema-like lesions of the nipple.Methods 74 cases of the eczema-like lesions of the nipple were taken cytological diagnosis after sampling of scrape on the local with a piece of slide.61 cases of them were checked with histological diagnosis and 13 cases of others were followed over three years.Results ①There were 51 malignant,4 suspected of malignant and one negative by diagnosis of cytology in 56 cases of Paget＇s diseases which were diagnosed by histopathology.②There were 2 benign tumor-like lesions and one suspected of malignant by diagnosis of cytology in 3 cases of adenoma of nipple which were diagnosed by histopathology.③There were 3 cases of the infection of herpes simplex virus were diagnosed by cytology which the viral inclusion body were found on their scrapping slides.④There were 2 negative（chronic inflammation lesion） were diagnosis by histopathology and others weren＇t found of tumor by followed over three years in 12 cases of chronic inflammation lesions were diagnosis by cytology.⑤The sensitivity of diagnosis of malignant tumor and the specificity of diagnosis of benign lesion and the overall accuracy of diagnosis were 98.2%（55/56）,94.4%（17/18） and 97.3%（72/74） respectively.The false negative rate,the potential false positive rate and the overall misdiagnostic rates were 1.8%（1/56）,5.6%（1/18）,and 2.7%（2/74） respectively.Conclusion For cytopathological examination of eczema-like lesions of the nipple,the glass slide scraping method provides broad applications with high diagnostic accuracy and advantages of simplicity,safety and efficiency.Certain limitations do exist in some atypical hyperplasia lesions of ductal epithelial cell,but can be resolved by histological examination of the lesion.