细胞蜡块联合免疫组化在胸腹水诊断中的应用研究

Application of Cell Wax Block Combined with Immunohistochemistry in the Diagnosis of Thoracoabdominal Fluid

目的探讨液基细胞学诊断技术与细胞蜡块联合免疫组化诊断技术在临床诊断胸腹水良恶性中的应用价值。方法选择2020年5月—2022年5月于张家港市第一人民医院就诊的疑似恶性胸腹水患者62例为研究对象,分别进行液基细胞学诊断、细胞蜡块联合免疫组化诊断,将活检病理诊断结果作为金标准,分别记录两种方案对胸腹水良恶性的诊断结果,计算并比较两种诊断方法的灵敏度、特异性与准确率。结果62例疑似恶性胸腹水患者通过活检病理诊断显示,52例患者诊断为恶性胸腹水,占比83.87%。其中恶性胸水患者43例,疾病诊断包括肺腺癌、乳腺癌、神经内分泌癌、胆管腺癌;恶性腹水患者9例,疾病诊断包括卵巢癌、胃肠道癌转移。细胞蜡块联合免疫组化诊断灵敏度96.15%、准确率93.55%均高于液基细胞学诊断的灵敏度78.85%和准确率74.19%,差异有统计学意义(χ^(2)=24.934、23.838,P<0.05)。结论细胞蜡块联合免疫组化方式诊断胸腹水良恶性具有较高的灵敏度,可有效提高疾病检出准确率,为进一步制订治疗方案提供支持。

Objective To explore the application value of liquid-based cytology and cell wax block combined with immunohistochemistry in the clinical diagnosis of benign and malignant thoracoabdominal fluid.Methods 62 patients with suspected malignant thoracoabdominal fluid who were treated in the First People's Hospital of Zhangjiagang City from May 2020 to May 2022 were selected as the study subjects.The liquid-based cytological diagnosis and the combination of cell wax block and immunohistochemistry diagnosis were performed,respectively.The pathological diagnosis results of biopsy were used as the gold standard.The diagnostic results of benign and malignant thoracoabdominal fluid of the two schemes were recorded respectively,and the sensitivity,specificity and accuracy of the two diagnostic methods were calculated and compared.Results The pathological diagnosis of 62 suspected malignant thoracoabdominal fluid patients showed that 52 patients were diagnosed as malignant thoracoabdominal fluid,accounting for 83.87%.Among them,43 patients with malignant pleural effusion were diagnosed as lung adenocarcinoma,breast cancer,neuroendocrine carcinoma and bile duct adenocarcinoma;nine patients with malignant ascites were diagnosed as ovarian cancer and gastrointestinal cancer metastasis.The sensitivity and accuracy of cell wax combined with immunohistochemistry were 96.15%and 93.55%,respectively,which were significantly higher than those of liquid-based cytology(78.85%and 74.19%),and the difference was statistically significant(χ^(2)=24.934,23.838,P<0.05).Conclusion The combination of cell wax and immunohistochemistry has high sensitivity in the diagnosis of benign and malignant thoracoabdominal fluid,which can effectively improve the accuracy of disease detection,provide support for further development of treatment plans.