常规涂片联合瘤包石蜡切片在胸水病理诊断中的应用

Application of conventional cytology smear combined with tumor sediment embedding paraffin section in pathological diagnosis of pleural effusion

目的探讨常规涂片联合瘤包石蜡切片辅以免疫组织化学技术在胸水细胞学病理诊断中的应用。方法收集2015年1月至2016年5月收检的胸水标本416例,以常规涂片189例为对照组(其中有活检组织学病理结果者68例),以常规涂片联合瘤包石蜡切片227例为观察组(其中有活检组织学病理结果者91例),辅以免疫组化技术的应用。基于组织病理学活检结果的比较,统计分析两组的阳性检出率、诊断准确率及胸水细胞学病理诊断的具体分型。结果两组胸水细胞学结果显示,对照组阳性检出率18.5%(35/189),观察组为34.8%(79/227),观察组阳性率明显高于对照组(P<0.01)。基于组织学病理活检结果分析两组的诊断准确率,对照组诊断准确率为80.9%(55/68),观察组为95.6%(87/91),观察组明显高于对照组(P<0.01)。诊断分型中以腺癌为主,占87.3%(69/79)。结论常规涂片联合瘤包石蜡切片在胸水细胞学病理诊断中可有效提高阳性检出率和准确率;辅以运用免疫组化技术可为临床对疾病的诊断、分型及个体化的精准靶向治疗提供可靠依据。

Objective To discuss the application of conventional cytology smear combined with tumor sediment embedding paraffin section plus immunohistochemical technique as supplementary means in cytologic pathological diagnosis of pleural effusion. Methods A total of 416 pleural effusion samples between January 2015 and May 2016 were collected. The specimens using conventional smears examination were served as control group（ 189 cases including 68 cases with biopsy pathology results） ,and the specimens using conventional smear plus tumor sediment embedding paraffin section were served as observation group （227 cases including 91 cases with biopsy pathology results）, in which immunohistochemistry was added as assistant for detectable positive eases. Based on histopathologieal biopsy results, the positive detectable rate, accuracy rate and the type of pathological diagnosis of pleural effusion were analyzed. Results For the cytological examination results, positive rate of pleural effusion in observation group [ 34. 8% （79/227）was significantly higher than that in control group [ 18.5% （35/189 ） , P 〈 0. 01 ]. Based on histopathologieal biopsy results, the diagnostic accuracy rate in observation group was significantly higher than that in control group [ 95.6% （87/91）vs 80.9% （55/68） ,P 〈 0.01 ]. Based on immunohistochemical marker,The type of pathological diagnosis mainly was adenocarcinoma [ 87.3% （69/79） ]. Conclusions The method of conventional cytology smear combined with tumor sediment embedding paraffin section can effectively improve the positive rate and accuracy rate in the pathological diagnosis of pleural effusion, and they together with immunohistochemical technique as a supplementary means can further provide reliable basis for diagnosis, typing of disease and individualized precise targeting therapy.