骨髓组织印片在细胞形态学诊断中的实用价值

The diagnostic value of bone marrow tissue imprints in cytomorphology

目的 研究骨髓组织印片在细胞形态学诊断中的应用价值.方法 收集2011年1月至2013年12月354份同步进行骨髓涂片、印片和切片检查的临床标本进行对比研究,分析形态学诊断差异性.结果 骨髓组织印片在极度减少、明显减少、正常、轻度增多、明显增多、极度增多组中有核细胞量评估性能优于涂片（P＜0.01）,而与切片相近（P＞0.05）.印片有核细胞数量减少者涂片大多减少,而涂片细胞减少者印片大多正常或增加.以骨髓切片有核细胞量变化为标准,有核细胞减少组中涂片与印片符合率均较高（87.5％和96.9％）;有核细胞量正常及增多组中印片符合率均高于涂片（87.8％和95.7％ vs 68.3％和55.8％）,其差异均有统计学意义（P＜0.01）.印片敏感度、特异度及约登指数指标性能评价总体上也优于涂片.浆细胞骨髓瘤（PCM）患者中印片浆细胞总量及幼稚浆细胞量高于涂片（42.73±10.47和13.60±4.83 vs 24.67±11.18和11.07±5.82）,其差异均有统计学意义（P＜0.05）.结论 骨髓组织印片兼有涂片和切片的特征,印片在评估有核细胞量及肿瘤细胞浸润度等方面优于涂片,骨髓涂片与印片快速联检可以提高骨髓细胞形态学诊断水平.

Objective To investigate the value of bone marrow imprints in the cytomorphology diagnosis.Methods A total of 354 cases of bone marrow smears,imprints,and sections were analyzed from January 2011 to December 2013 to detect morphological diagnosis difference.Results Bone marrow imprints in groups of extremely reduced,significantly reduced,normal,slightly increased,increased significantly,and extreme increase were better than that of smear which nucleated cells quantity assessment（P 〈 0.01）.Smears and imprints were similar （P 〉0.05）.Imprints nucleated cell number decreased mostly were the same as smear,but smear reduced imprints mostly normal or increased.The bone marrow sections nucleated cells quantity as the standard,smears and imprints had high coincidence rate in the group of nucleated cells reduced （87.5% and 96.9%）,and imprints were higher than smear in the group of nucleated cells quantity in normal and increased（87.8% and 95.7% vs 68.3% and 55.8%）,and the difference was statistically significant.Imprints were better than smear in specificity,Youden index,and sensitivity.Patients with plasma cell myeloma （PCM） imprint plasma cell volume and immature plasma cells were higher than that of smear （42.73 ± 10.47 and 13.60 ± 4.83 vs 24.67 ± 11.18 and 11.07 ± 5.82） with a statistically significant difference （P 〈 0.05）.Conclusions Imprints have characteristics both smear and sections,and imprints are superior to smears in assessment of nucleated cells and tumor cell invasion degree.Smear combined with imprints can improve the diagnosis level of bone marrow cell cytomorphology.