垂体瘤临床与病理诊断的一致性分析研究

Consistency Analysis on the Clinical Diagnosis and Pathologic Diagnosis of Pituitary Adenoma

目的通过对GH瘤、PRL瘤和ACTH瘤等垂体激素水平的测定与术后病理免疫组化指标的一致性分析,对术前的临床诊断进行评估。方法对所有患者在手术前影像学检测及垂体激素水平的测定,将术前具有典型临床表现、影像特征和血清检查中显示的激素水平作为临床诊断,术后病理免疫组化指标作为病理诊断。采用SPSS 20.0统计软件的交叉表分析工具进行三种激素的临床与免疫组化诊断的一致性分析。通过Kappa值判断两种诊断方法的一致性。结果 GH瘤临床与病理诊断的一致性Kappa值=0.431,PRL瘤临床与病理诊断的一致性Kappa值=0.543,ACTH瘤临床与病理诊断的一致性Kappa值=0.418。Kappa值均大于0.4,表明三种内分泌激素瘤临床与病理诊断具有一致性;p=0.00,说明一致性具有统计学意义。结论垂体激素水平的测定有助于垂体瘤的临床诊断及手术方式的选择,并可以作为术后疗效的判定。患者术后进行免疫组化病理检查,可以减少漏诊或误诊率,使垂体瘤的临床与病理诊断保持一致性,并改善预后。

Objectives To evaluate the accuracy of clinical diagnosis of pituitary adenoma through analysis on the consistency between the hormone levels and immunohistochemical parameters of GHomas,PRLomas and ACTHomas.Methods To conduct tests on the preoperational imaging detections and pituitary hormone level of all the patients,and also postoperative pathology examinations were carried out and their results were regarded as reference of postoperative pathologic diagnosis.All data were statistically analyzed via SPSS 20.0 and the consistencies were determined based on the Kappa values.Results The Kappa values of diagnosis consistency of GH adenoma,PRL adenoma and ACTH adenoma were 0.431,0.543 and 0.418,respectively.All Kappa values were greater than 0.4,which revealed the consistency of PA between clinical diagnosis and postoperative pathologic diagnosis occurred.The date had statistical significance（p=0.00）.Conclusions The testing of pituitary hormone levels was helpful for the selection of clinical diagnosis and operation modes,and also could as a proper evaluation of postoperative effectiveness.Moreover,to conduct immunohistochemical detection after an operation could reduce the error diagnosis rate,improve prognosis and keep the consistency of PA between clinical diagnosis and postoperative pathologic diagnosis,as well as develop the prognosis of the diseases.