经直肠超声引导下前列腺细针穿刺中液基薄层细胞学及免疫细胞化学诊断前列腺癌的应用价值

Clinical value of liquid based cytology test and immunocytochemistry in the diagnosis of prostate cancer by transrectal ultrasound-guided fine needle aspiration of the prostate

目的:探讨经直肠超声引导下前列腺细针穿刺细胞学中液基薄层细胞学(thinprep liquid based cytology test,TCT)及免疫细胞化学(immunocytochemistry,ICC)诊断前列腺癌的应用价值。方法:收集321例前列腺疾病患者细针穿刺物,TCT及传统涂片(conventional smear,CS)制片,其中153例有术后对照,回顾性比较不同制片方法诊断灵敏度、特异度及前列腺癌确诊率,分析漏诊及误诊原因,并结合ICC及前列腺癌分级,寻求早期诊断前列腺癌的有效方法。结果:TCT灵敏度及特异度高于CS,假阳性率及假阴性率减少,尤其是Gleason评分≤7分时明显。TCT联合ICC后,灵敏度及前列腺癌确诊率更高。结论:TCT和CS均能鉴别前列腺病变的良恶性,但TCT对于Gleason评分≤7分的前列腺癌患者有更高诊断价值,ICC辅助诊断后,其价值更高,是前列腺癌早期诊断的有效方法。

Objective:To investigate the value of liquid based thin-layer cytology and immunocytochemistry in the diagnosis of prostate cancer by transrectal ultrasound-guided prostate fine needle aspiration cytology.Methods:Data of 321 patients were retrospectively studied,who underwent transrectal ultrasound guided fine needle cytology examination,in which TCT and conventional smear(CS)were used at the same time,and 153 cases had histologic diagnosis.Using the histologic diagnosis as the gold standard,we compared the sensitivity,specificity and the positive rate of prostate carcinoma of this two kinds of producers,analyzed the causes of diagnostic errors and missed diagnosis.Combined with ICC and Gleason grading of prostatic carcinoma,the effective tool of early diagnosising for prostatic carcinoma was investigated.Results:The sensitivity and specificity of TCT were higher than CS.The false positive rate and false negative rate reduced,especially in the group of Gleason score≤7.Combining with ICC,the difference of sensitivity and the positive rate of prostate cancer was higher.Conclusion:Both TCT and CS can identify benign and malignant of prostate lesions,but TCT has higher diagnostic value for prostate cancer patients which in the group of Gleason score≤7.Combining with ICC,the results are better.TCT and ICC are effective tools for the early diagnosis of prostate cancer.