液基细胞涂片联合染色体检测在恶性胸水诊断中的应用

Application of Thin Prep cytologic test(TCT) combined with chromosome detection in diagnosis of malignant pleural effusion

目的探讨液基细胞检测联合染色体分析在恶性胸水中的诊断价值。方法 218例胸水患者均留取胸水60 ml,同时进行液基细胞检测和染色体分析,并与有组织病理学诊断结果的40例恶性胸水进行对照。结果 (1)液基细胞和染色体与组织病理学检测结果对照:恶性胸水确诊的共40例,其中单纯采用液基细胞检查诊断恶性胸水85%(34/40);单纯采用染色体诊断恶性胸水92.5%(37/40)。(2)液基细胞及染色体串、并联试验在恶性胸水中的诊断评价:两者采用串联试验与并联试验诊断恶性胸水的灵敏度分别为82.5%、95.0%;特异度为100%、98.3%;一致率为96.8%、97.7%;约登指数为82.5%、93.3%;Kappa值为88.5%、92.4%;阳性预测值为100%、92.7%;阴性预测值为96.2%、98.9%。结论液基细胞检测及染色体对诊断恶性胸水具有重要的临床诊断价值,两者联合检测能提高恶性胸水的准确率。

Objective To explore the diagnostic value of ThinPrep cytologic test （TCT） combined with chromosome detection in di-agnosis of malignant pleural effusion. Methods Sixty ml pleural effusion were respectively collected from 218 patients with pleural ef-fusion, and detected by TCT combined with chromosome detection. 40 cases of malignant pleural effusion diagnosed by histopathology as the control group. Results （1） Compared the results of TCT and Chromosomeshistopathology tests：40 cases maligant pleural effu-sion were confirmed. The sensitivity of detection of malignant pleural effusion only by TCT was 85% （34/40） and 92.5% （37/40） only by chromosome detection. （2） The diagnosis evaluation of maligant pleural effusion used by series and parallel pattern of both TCT and chromosome detection： the sensitivity in diagnosis of malignant pleural effusion used by both series and parallel pattern was 82.5%and 95.0%respectively;the specificity was 100.0%and 98.3% respectively; the coincidence rate was 96.8% and 97.7% respectively; the Youden＇s index was 82.5%and 93.3%respectively;the Kappa value was 88.5%and 92.4%respectively;the positive predictive value was 100%and 92.7%respectively, and negative predictive value was 96.2%and 98.9%respectively. Conclusions TCT and chromosome detection in diagnosing maglignant pleural effusion have important clinical diagnostic value. The combination of TCT and chromosome detection can improve the accuracy rate of diagnosting malignant pleural effusion.