细胞块切片联合免疫组化对胸腔积液诊断价值分析

Analysis of diagnostic value of cell block section combined with immunohistochemistry for pleural effusion

目的出现胸腔积液的患者病情较为严重且预后较差,而胸腔积液的细胞病理学检查结果对鉴别病变类型、性质及临床分期具有重要意义,可为临床治疗方案制定提供重要依据,进而提高患者生存质量。本研究探讨细胞块切片联合免疫组化对胸腔积液的诊断价值。方法选取荥阳市人民医院2017-10-15-2019-02-12收治的胸腔积液患者90例,患者入组后均采集胸腔积液标本,每例标本收集后立即行普通细胞涂片检查、细胞块切片联合免疫组化检查,并比较其特异度、灵敏度和准确度,比较常规涂片和细胞块切片HE染色结果。结果细胞块切片联合免疫组化阳性检出率为56.67%,略高于常规细胞涂片HE染色的46.67%,差异无统计学意义,χ2=1.802,P=0.180。细胞块切片联合免疫组化诊断良性恶性胸腔积液的灵敏度为91.11%,高于常规细胞涂片HE染色的75.00%,差异有统计学意义,χ2=5.134,P=0.024。细胞块切片联合免疫组化诊断良性恶性胸腔积液的特异度为85.29%,高于常规细胞涂片HE染色的55.88%,差异有统计学意义,χ2=7.083,P=0.008。细胞块切片联合免疫组化诊断良性胸腔积液、恶性胸腔积液的准确度为88.89%,高于常规细胞涂片HE染色的67.78%,差异有统计学意义,χ2=11.817,P=0.001。细胞块切片联合免疫组化与病理检查结果具有较高一致性,Kappa=0.764;常规细胞涂片HE染色与病理检查结果一致性较差,Kappa=0.311。结论细胞块切片联合免疫组化可准确鉴别胸腔积液良恶性,可为临床治疗方案制定提供重要依据。

OBJECTIVE Patients with pleural effusion are more serious and have a poor prognosis.The cytopathological examination results of pleural effusion are of great significance in identifying the type,nature and clinical stage of the disease,and can provide an important basis for the formulation of clinical treatment plans,thereby improving patients quality of life.This study explored the diagnostic value of cell block section combined with immunohistochemistry for pleural effusion.METHODS A total of 90patients with pleural effusion who were admitted to Xingyang People’s Hospital from October 15,2017to February 12,2019were selected.After the patients were enrolled in the group,samples of pleural effusion were collected,and normal cell smears,cell block sections combined with immunohistochemical examinations were performed immediately after each sample was collected,and their specificity,sensitivity and accuracy were compared.The HE staining results of conventional smears and cell block sections were compared.RESULTS The positive detection rate of cell block sections combined with immunohistochemistry was 56.67%,which was slightly higher than that of conventional cell smears with HE staining(46.67%,χ2=1.802,P=0.180).The sensitivity of cell block section combined with immunohistochemistry in diagnosing benign and malignant pleural effusion was 91.11%,which was higher than that of HE staining of conventional cell smear(75.00%,χ2=5.134,P=0.024).The specificity of cell block section combined with immunohistochemistry in the diagnosis of benign and malignant pleural effusion was 85.29%,which was higher than that of HE staining of conventional cell smear(55.88%,χ2=7.083,P=0.008).The accuracy of cell block section combined with immunohistochemistry in diagnosing benign pleural effusion and malignant pleural effusion was 88.89%,which was higher than that of HE staining of conventional cell smear(67.78%,χ2=11.817,P=0.001).The results of cell block slices combined with immunohistochemistry and pathological examination had high consistency,Kappa=0.764.Conventional cell smear HE staining and pathological examination results had poor consistency,Kappa=0.311.CONCLUSION The combination of cell block slices and immunohistochemistry can accurately distinguish benign and malignant pleural effusions,which can provide an important basis for the formulation of clinical treatment plans.