AgNOR定量分析在胸腹水及针吸细胞学辅助诊断中的意义

Significance of AgNOR quantitative analysis in cytological diagnosis of pleural and peritoneal effusions, and fine needle aspiration

目的 利用核仁组成区技术 (AgNOR)区分良性、可疑癌及恶性细胞 ,并探讨AgNOR分型与癌细胞类型的关系。方法 应用胶银染色技术检测 5 12例胸腹水及针吸涂片。结果 良性细胞均数 ( 2 88± 0 6 4)与恶性细胞均数 ( 7 45± 2 6 7)差异极显著 (P <0 0 1) ,说明产生假阳性的机会很小。良性细胞与可疑癌细胞均数 ( 5 19± 0 88) ,可疑癌细胞与恶性细胞均数均差异极显著 (P <0 0 1) ,有助于识别可疑癌细胞。鳞状细胞癌与腺癌 ,鳞状细胞癌与小细胞未分化癌 ,腺癌与小细胞未分化癌均数间均差异极显著 (P <0 0 1) ,提示癌细胞的类型不同 ,均数亦有差异。AgNOR在腺癌细胞中颗粒粗大 ,色深 ;在鳞癌和小细胞未分化癌中颗粒多为弥散型 ,细小 ,色浅。用AgNOR计数标准判断良恶性 ,其敏感性为 94 1% ,特异性为 92 3%。结论 细胞学普通染色诊断困难时 ,AgNOR银染技术可以辅助诊断。AgNOR分型与癌细胞类型有显著相关性 (P <0 0 5 )。

Objective To identify cells of benign from those of maligmant and suspicious cancer in body cavity fluid and FNA smears by AgNORs technique. Methods Ag staining was used in the smears of 512 cases. Results Mean difference between benign group and malignant group was obvious (P<0.01). Rate of false positivity was low. Mean difference between benign cell, suspicious cancer cell and malignant cells was clear (P<0.01). To identify suspicious cancer cells was easy. There was also discrepancy either between squamous cancer cell and adenocarcinoma cell or between squamous cancer cell and small cell undiffereniated cancer cells. This difference also existed in adenocarcinoma cell and small cell undiffereniated cancer cells (P<0.05). Particles were bigger and stronger in adenocarcinoma than those in squamous cancer cell and small cell undiffereniated cancer cells. There was obvious relation between types of AgNOR particles and those of cancer cell (P<0.01). AgNOR sensitivity and specificity were 94.1% and 92.3% respectively by AgNOR count criterion. Conclusions AgNOR technique can help make diagnosis for which it is difficult to do so by routine staining. The types of cancer cell and AgNOR are correlative.