应用细胞蜡块辅助浆膜腔积液细胞学精准诊断

Application of cell blocks to assist in precise cytological diagnosis of serous effusion

目的探讨细胞蜡块及免疫组织化学对浆膜腔积液精准诊断的重要性。方法回顾性研究2018—2022年北京医院病理科浆膜腔积液标本3124例,包括胸腔积液2213例,腹腔积液768例,心包积液143例。男性1699例(54.4%),女性1425例(45.6%);平均年龄69岁。其中1292例制作了细胞蜡块,并行免疫组织化学检查。结果诊断恶性肿瘤百分比从细胞蜡块制作前64.9%(839/1292)提高到制作后84.0%(1086/1292),其中1086例恶性肿瘤明确了组织类型和/或来源;不明确的诊断包括可疑恶性及不典型增生,分别从13.3%(172/1292)和18.8%(243/1292)降低到0.1%(1/1292)和0.4%(5/1292);阴性率从3.0%(38/1292)升高到15.5%(200/1292),差异具有统计学意义(Pearson卡方=12.739,P<0.01)。结论以细胞蜡块制作为基础的免疫组织化学检查显著提高了浆膜腔积液恶性诊断率,同时可鉴别组织类型和肿瘤来源,减少不明确的诊断。

Objective To investigate the importance of cell block and immunohistochemistry in the accurate diagnosis of serous effusion.Methods A retrospective study was conducted on 3124 cases of serous effusion from the Department of Pathology,Beijing Hospital from 2018 to 2022,include 2213 cases of pleural effusion,768 cases of peritoneal effusion,143 cases of pericardial effusion.There were 1699 males(54.4%)and 1425 females(45.6%),average age 69 years old.Of which 1292 cases were prepared with cell blocks and examined with immunohistochemical stain.Results The percentage of malignant diagnosis increased from 64.9%(839/1292)to 84.0%(1086/1292)after cell block preparation,and 1086 cases were accurately diagnosed with histological type and/or origin of primary tumor.The undetermined diagnosis of suspected malignancy decreased from 13.3%(172/1292)to 0.1%(1/1292)and that of atypical hyperplasia from 18.8%(243/1292)to 0.4%(5/1292).The negative result for malignancy rate increased from 3.0%(38/1292)to 15.5%(200/1292).The differences highlighted above were statistically significant(Pearson′s chi-squared test=12.739,P<0.01).Conclusion Application of immunohistochemistry based on cell block can significantly improve malignant diagnosis in serous effusion,identify tumor origin and histological type as well as decrease the uncertain diagnosis.