细针穿刺细胞块技术联合免疫组化在腮腺肿瘤诊断中的应用

Application of fine needle aspiration cell block technique combined with immunohistochemistry in the diagnosis of parotid gland tumors

目的 细针穿刺细胞学检查(fine needle aspiration cytology,FNAC)在头颈肿瘤的术前辅助诊断中应用广泛,但其对唾液腺肿瘤诊断价值尚存在争议。本研究旨在评估FNAC细胞联合GFAP、Fas-FasL系统免疫组化对腮腺肿瘤的诊断价值。方法 回顾性分析2014年9月至2019年6月期间行腮腺肿瘤FNAC及手术治疗的患者;依据FNAC的诊断分为疑似恶性或恶性,良性;依据组织病理学诊断分为恶性,良性;将FNAC与组织病理学诊断相比,明确FNAC在腮腺肿瘤中的诊断特性;并对53例FNAC细胞块行GFAP、Fas-FasL免疫组化,评价其临床价值。结果 347例病例被纳入研究,FNAC中疑似恶性或恶性68例,良性279例;组织病理学诊断中恶性52例,良性295例,其中最多见的恶性肿瘤为ACC(19/347,5.48%),最多见的良性肿瘤为PA(193/347,55.62%);FNAC对腮腺恶性肿瘤诊断的阳性预测值为57.35%,阴性预测值为95.34%,灵敏性为75.00%,特异性为90.17%,对347例病例诊断的准确率为87.90%,FNAC与组织病理学诊断有中等一致性(Kappa=0.578)。FNAC的假阴性、假阳性诊断较多出现于ACC与PA中,通过对PA组和ACC组GFAP,Fas及FasL免疫组化,结果示PA胞浆内有棕色颗粒呈阳性表达,ACC组全部癌细胞胞浆内、胞膜均无棕色颗粒,呈阴性表达,有统计学意义(P<0.05)。结论 FNAC对腮腺良性肿瘤的诊断更为准确,在评估疑似腮腺恶性肿瘤时联合FNAC细胞块行GFAP、Fas-FasL免疫组化可帮助鉴别ACC、PA,以减少假阴性、假阳性结果。

Objective Fine needle aspiration cytology(FNAC)is widely used in preoperative auxiliary diagnosis of head and neck tumors, but its diagnostic value for salivary gland tumors remains controversial. This study aimed to evaluate the diagnostic value of FNAC cells combined with GFAP and Fas-FasL system immunohistochemistry in parotid tumors. Methods The patients who underwent FNAC and surgical treatment for parotid tumors from September2014 to June 2019 were retrospectively analyzed. According to FNAC diagnosis is divided into suspected malignant or malignant, benign. According to histopathological diagnosis, they were divided into malignant and benign.Compared with histopathological diagnosis, the diagnostic characteristics of FNAC in parotid tumors were clarified.GFAP and Fas-FasL immunohistochemistry were performed on 53 FNAC cell blocks to evaluate their clinical value.Results 347 cases were included in the study, 68 cases were suspected malignant or malignant, 279 cases were benign. In histopathological diagnosis, 52 cases were malignant and 295 cases were benign. ACC was the most common malignant tumor(19/347, 5.48%), and PA was the most comm on benign tumor(193/347, 55.62%).The positive predictive value of FNAC in the diagnosis of parotid malignant tumors was 57.35%, the negative predictive value was 95.34%, the sensitivity was 75.00%, and the specificity was 90.17%. The diagnostic accuracy of 347 cases was 87.90%. FNAC was moderately consistent with histopathological diagnosis(Kappa=0.578). The false negative and false positive diagnosis of FNAC mostly appeared in ACC and PA. Through the immunohistochemistry of GFAP, Fas and FasL in PA group and ACC group, the results showed that brown granules were positively expressed in the cytoplasm of PA, and there were no brown granules in the cytoplasm and membrane of all cancer cells in ACC group, showing negative expression, with statistics(P <0.05). Conclusion FNAC is more accurate in the diagnosis of benign parotid tumors. GFAP and Fas-FasL immunohistochemistry combined with FNAC cell blocks in the evaluation of suspected malignant parotid tumors can help to identify ACC and PA, so as to reduce false negative and false positive results.