淋巴结转移性鼻咽癌针吸检查中细胞块样本的应用

Application of FNA cell block sample from lymph nodes in metastatic nasopharyngeal carcinoma

目的探讨细针吸取(FNA)涂片联合细胞块(CB)切片、免疫组化标记(IHC)和EBER原位杂交在淋巴结转移性鼻咽癌中的应用。方法采用友谊式细针穿刺器和21G注射针对31例鼻咽癌头颈部淋巴结转移病灶获取样本制片,观察其细胞形态学及CB组织形态学特征、IHC和EBER原位杂交表达。比较分析单纯细胞涂片、细胞涂片联合CB切片、细胞涂片联合CB切片及IHC和EBER原位杂交3种不同方式对鼻咽癌头颈部淋巴结转移病灶的诊断准确率。结果 1所有病例的细胞涂片及CB切片均显示为非角化性癌的形态学特征。2CB切片IHC和EBER原位杂交显示:肿瘤细胞CK5/6、p63、Ki-67及EBER均为(+);LCA和CK7均呈(-)。33种不同方式对鼻咽癌头颈部淋巴结转移病灶的诊断准确率比较显示:单纯细胞涂片诊断的敏感度(90.3%,28/31)及确诊率(74.2%,23/31)最低;细胞涂片联合CB切片诊断的敏感度(93.5%,29/31)及确诊率(77.4%,24/31)居中;细胞涂片联合CB切片及IHC和EBER原位杂交诊断的敏感度(96.8%,30/31)及确诊率(96.8%,30/31)最高。结论FNA细胞涂片联合CB切片、IHC及EBER原位杂交的方式,对头颈部淋巴结转移性鼻咽癌的早期诊断、寻找原发灶、治疗以及预后判断具有重要意义。

Objective To investigate the application value of the fine needle aspiration （FNA） smears combined cell block （CB） section, immunohistochemistry （IHC） and EBER in situ hybridization in metastatic lymph node of nasopharyngeal carcinoma. Methods A total of 31 fine needle aspiration biopsy cases of metastatic lymph nodes of nasopharyngeal carcinoma were selected, which were performed using our patented aspirators （Youyi-style aspirator） with 21G （0. 8 mm diameter） needles. The cytomorphology, CB-histomorphology, IHC and EBER in situ hybridization of the FNA simples were carried out and evaluated for the sensitivity and the final diagnostic rate among three different methods including simple cell smear, smear combined CB sections, and IHC and EBER in situ hybridization. Results All cases shown the morphological characteristics of non-keratinizing carcinoma in cell smears and CB sections. The tumor cells exhibited high positively expressed CK5/6, P63, Ki-67 （high in undifferentiated type carcinomas and lower in differentiated type carcinomas） and EBER （96. 8%, 30/31 cases）, but not LCA and CK7 in the CB sections. The sensitivity and the final diagnostic rate were the lowest in the simple cell smears （90. 3%, 28/31 and 74. 2%, 23/31 cases） ; moderate in smears combined CB section （93.5%, 29/31 cases and 77.4%, 24/31 cases） and the highest in smears combined CB section, IHC and EBER （96. 8%, 30/31 and 96. 8%, 30/31 cases）, respectively. Conclusion FNA smears combined CB sections, IHC and EBER in situ hybridization have a practical significance in early diagnosis of metastatic lymph node in the head and neck of nasopharyngeal carcinoma, primary tumor location, treatment and prognosis evaluation.