浆膜腔积液沉渣包埋切片中检测P53、Ki-67鉴别良恶性细胞的价值

Differential diagnostic value of P53 and Ki-67 immunostaining for distinguishing benign from diagnosis effusion fluid specimens of serous cavity

目的:探讨P53、Ki-67免疫细胞化学染色在鉴别良、恶性浆膜腔积液病理诊断中的应用价值。方法:收集103例浆膜腔积液沉渣石蜡包埋标本,其中恶性浆膜腔积液50例,良性浆膜腔积液53例,行P53、Ki-67免疫细胞化学染色。统计分析P53、Ki-67在良、恶性浆膜腔积液中的阳性率、敏感性,特异性及联合应用P53、Ki-67的鉴别诊断价值。结果:P53阳性率在50例恶性浆膜腔积液中为78.00%(39/50),显著高于良性浆膜腔积液的3.77%(2/53)(P<0.05);P53诊断浆膜腔积液的敏感性为78.00%,特异性为96.23%,阳性预测值(positive predictive value,PPV)95.12%,阴性预测值(negative predictive value,NPV)82.26%;Ki-67在恶性浆膜腔积液中阳性率为76.00%(38/50),显著高于良性浆膜腔积液的20.75%(11/53)(P<0.05);Ki-67诊断浆膜腔积液的敏感性为76.00%,特异性为79.24%,PPV 77.55%,NPV 77.78%。P53、Ki-67均阳性的有32例,其中31例(96.88%)为恶性浆膜腔积液;P53、Ki-67均阴性的有45例,其中41例(91.11%)为良性浆膜腔积液。结论:检测浆膜腔积液沉渣包埋切片中P53、Ki-67的表达,能够提高诊断准确性,特别是两指标联合应用对鉴别疑难病例有一定的临床应用价值。

Objective： To evaluate the utility of P53 and Ki-67 immunocytochemical markers in differentiating benign from malignant tumor cells in the cytologic diagnosis of effusion fluid specimens of serous cavity. Methods： 103 effusion fluid specimens with the cell block paraffin section were enrolled into study. 50 cases were malignant cells and 53 cases were benign based on cytomorphologic features. The slides were subjected to immunocytochemical staining for P53 and Ki-67. Statistical analysis of the positive rate, sensitivity, specificity of P53 and Ki-67 were carried out in benign and malignant serous cavity effusion, and also the differential diagnosis value of joint application of both stains were calculated. Results：P53 immunostaining showed nuclear positivity with 78.00%（39/50） positive rate, and higher than benign effusions with 3.77%（2/53） positive rate（P〈0.05）. P53 had 78.00% sensitivity, 96.23% specificity, 95.12% positive predictive value（PPV）, and 82.26%negative predictive value （ NPV ） . Ki-67 immunostaining was positive in malignant effusions with 76 . 00%（ 38/50 ） positive rate, and higher than in benign effusions with 20.75%（11/53） positive rate（P〈0.05）. Ki-67 had 76.00% sensitivity, 79.24%specificity, 77.55% PPV, and 77.78% NPV. Among the 32 cases that coexpressed both antigens, 31 cases（96.88%） were malignant. 41 out of 45 cases（91.11%） that showed negative results for both antigens were benign. Conclusion： Utility of P53 and Ki-67 immunocytochemical stain can improve the diagnostic accuracy, especially the two indicators combined application of identification of clinical cases has certain clinical application value.