胸腔积液细胞块切片免疫组化染色技术鉴别诊断肺腺癌的临床研究

Clinical study of pleural effusion cell block sections immunohistochemical staining technique in differential diagnosis of lung adenocarcinoma

目的探讨胸腔积液细胞块切片免疫组化染色技术对肺腺癌的鉴别诊断价值。方法选取76例胸腔积液患者作为研究对象,采集胸腔积液标本,分别行细胞块切片免疫组化染色检查和常规细胞涂片检查,检测指标包括MOC-31、CK7、TTF-1、CD15等,比较两种方法鉴别诊断肺腺癌的敏感性。结果细胞块切片HE染色与常规涂片HE染色对胸腔积液的诊断结果比较无明显差异(χ~2,P>0.05)。细胞块切片免疫组化染色对恶性胸腔积液的诊断率明显高于常规涂片免疫组化染色(χ~2,P<0.05)。肺腺癌细胞的TTF-1、CEA、Ber EP4、CD15、MOC-31、CK7阳性表达率较高,良性细胞的Desmin、WT-1、Calretinin、CK5/6阳性表达率较高。肺腺癌与间皮性肿瘤间的Desmin、WT-1Calretinin、CK5/6、TTF-1、CEA、Ber EP4、CD15、MOC-31、CK7阳性表达率比较有显著性差异(P<0.05)。结论细胞块切片是临床诊断恶性胸腔积液的有效手段,联合免疫组化染色技术能够为临床鉴别诊断肺腺癌提供可靠依据。

Objective To investigate the pleura1 effusion cell block sections immunohistochemical techniques for diagnosis and differential diagnosis of lung adenocarcinoma. Methods A total of 76 cases of patients with pleural effusion were selected as the research object, and their specimens of pleural effusion were collected. Then they were given cell slice immunohistochemistry staining examination and conventional smears and indexes including MOC-31, CK7, TTF-1, CD15. The sensitivity of the two methods in the differential diagnosis of lung adenocarcinoma cancer was compared. Results There was no significant difference in the diagnosis of pleural effusion between HE staining and routine smear HE staining in the cell block sections （P 〉 0. 05）. The diagnosis of malignant pleural effusion was significantly higher than that of routine smear immunohistochemical staining （ P 〈 0. 05 ）. The positive expression rate of lung adenoeareinoma cells TTF-1, CEA, BerEP4, CD15, MOC-31 and CK7 was higher, and the positive rate of benign cells of Desmin, WT-1, Calretinin, and CK5/6 was higher. There was certain difference in the positive expression rate of Desmin, WT-1Calretinin, CK5/6, TTF-1, CEA, BerEP4, CD15, MOC-31 and CK7 between lung adenoeareinoma and mesothelial tumor （ P 〈 0. 05 ）. Conclusion The cell block is an effective method for clinical diagnosis of malignant pleural effusion, and immunohistochemieal staining technique provides a reliable basis for clinical diagnosis of lung cancer.