细胞团块收集器联合免疫标记在良、恶性胸水中的应用研究

Application of cell mass collector combined with immune markers in diagnosis of benign and malignant pleural effusion

目的 探讨细胞团块收集器联合免疫标记在良、恶性胸水中的应用.方法 采用细胞团块收集器收集胸水,将临床送检的115例胸水制作细胞切片,苏木精-伊红染色法（HE）、免疫组织化学法染色,行细胞形态学观察及鉴别诊断,并与2009～2013年送检的胸水标本经传统细胞涂片或液基薄层技术细胞诊断结果进行比较研究.结果 115例胸水中,经免疫及形态学证实为恶性胸水18例,恶性细胞检出率为16％,传统细胞涂片胸水癌细胞检测阳性率为5％,差异有统计学意义（P＜0.05）.在异型性细胞中,Ki-67、癌胚抗原（CEA）、甲状腺转录因子-1（TTF-1）、Napsin-A、细胞角蛋白7（CK7）在肺腺癌细胞中表达较好;而Calretinin、间皮细胞（MC）、Wilms肿瘤基因（WT1）在间皮细胞中表达较好,其表达率在良、恶性胸水中比较,差异有统计学意义（P＜0.05）.结论 利用细胞团块联合免疫标记能极大地提高良、恶性胸水诊断的准确率,并能客观地对恶性肿瘤细胞进行分型,提高癌细胞检出率、准确率,有利于肿瘤分型.

[Objective] To apply cell mass collector combined with immune markers in the diagnosis of benign and malignant pleural effusion. [Methods] Pleural effusion of 115 cases was collected with the cell clump collector. Effusion smears were checked through H.E. staining and immunohistochemical staining. Cell morphology was observed and differential diagnosis was made. Then the results were compared with the diag- nostic results of traditional cell smear and thin liquid layer technology for pleural effusion from 2009 to 2013. [Results] In 115 cases with pleural effusion, 18 cases were confirmed to have malignant pleural effusion by immunohistochemistry and morphology. The positive rate of malignant cells was 16% while it was 5% using traditional cell smear of pleural effusion, and there was a significant difference between them （P 〈 0.05）. CEA, Napsin-A, TTF-1, CK7 and Ki-67 were expressed in the lung adenocarcinoma cells, while MC, WT1 and calretinin were expressed in mesothelial cells, and there were significant differences in the positive rates be- tween benign and malignant pleural effusion （P 〈 0.05）. [Conclusions] Application of cell mass collector combined with immune markers can improve the diagnosis of benign and malignant pleural effusion, increase the detection rate and accuracy and facilitate classification of malignant tumor cells.