细胞蜡块免疫标记在浆膜腔积液腺癌细胞病理学诊断中的临床价值

Clinical significance of cell block immunolabelling in cytopathologic diagnosis of adenocarcinoma of serous cavity effusion

目的探讨细胞蜡块免疫标记在浆膜腔积液腺癌细胞病理学诊断中的临床价值。方法选取通过细胞普通涂片筛选出的66例可疑异型腺上皮的浆膜腔积液标本。每例标本同时采用细胞普通涂片、细胞普通涂片免疫标记和细胞蜡块切片免疫标记进行最终诊断。分析比较三种方法在浆膜腔积液细胞病理学诊断中的价值。结果 66例标本中通过细胞普通涂片、细胞普通涂片的免疫标记、细胞蜡块切片的免疫标记确诊为腺癌细胞的检出率分别为43.9%(29/66)、75.8%(50/66)和92.4%(61/66)。后两者方法均较仅依赖细胞普通涂片阳性检出率高,且差异有统计学意义(75.8%,92.4%vs 43.9%,P<0.01),细胞蜡块切片较细胞普通涂片的免疫标记阳性检出率高,差异有统计学意义(92.4%vs 75.8%,P<0.01)。细胞普通涂片仅依赖细胞形态学进行诊断,难以确定异型细胞类型、性质及其来源;细胞普通涂片免疫标记染色背景深,定位不准确,判断困难;细胞蜡块切片免疫标记染色背景清晰,定位准确,易于判断。61例浆膜腔积液腺癌细胞标本中,胸水38例、腹水22例,心包积液1例;结合免疫标记结果,其中肺来源33例,胃肠道来源21例,卵巢、子宫内膜来源6例,乳腺来源1例。结论与细胞普通涂片的免疫标记相比,细胞蜡块的免疫标记更具优势,不仅有助于细胞病理学阳性检出率的提高,而且有利于腺癌细胞的鉴别诊断及其组织器官来源的判断。

Objective To explore the clinical significance of cell block immunolabelling in cytopathologic diagnosis of adenocarcinoma of serous cavity effusion. Methods Sixty-six samples of suspicious serous cavity effusion were screened by conventional cells smear. All samples were dignosed by conventional cell smear, conventional cell smear assisted with immunochemistry and immunoehemistry of cell block section,respectively. Results The positive rates of samples by immunochemistries of conventional cell smear and cell block section were significantly higher than that by conventional cell smear （75.8% ,92.4% vs 43.9% , P 〈 0.01 ）. The positive rate of sam- ples by immunochemistry of cell block section was significantly higher than that by conventional cell smear assisted with immunochemis- try （92.4% vs 75.8% ,P 〈 0.01 ）. Conventional cell smear only showed the morphology of atypical cells, but could not diagnose the type, property and origin. The immunochemieal staining of conventional cells smear showed observable background color, inaccurate ex- pression location and dilemmatic estimation. The immunochemistry of cell block section showed distinct background color, accurate ex- pression location and easy estimation. Of 61 samples diagnosed as adenocarcinoma of serous cavity,38 specimens originated from pleural effusion,22 specimens from ascitie effusion and one specimen from pericardial effusion. Thirty-three cases were diagnosed with lung cancer,21 cases of digestive tract cancer,6 cases of ovary or endometrium cancer and one case of breast cancer. Conclusion Com- pared with conventional cell smear assisted with immunochemistry, immunochemistry of cell block section has more advantages. It is beneficial not only to enhance the positive detection rates of cytopathologie diagnosis, but also to evaluate the differential diagnosis and origin of adenocarcinoma.