DNA定量分析与液基细胞学检查对恶性腹腔积液的诊断价值

Diagnostic value of DNA quantitative analysis and thinprep cytologic test in diagnosis of malignant pleu-ral effusion and ascites

目的：探讨DNA定量分析和液基细胞学检查对恶性腹腔积液诊断的应用价值。方法选取湖南省岳阳市二人民医院58例腹腔积液患者，收集其腹腔积液分别进行DNA定量分析和液基细胞学检查，比较二者的敏感性和特异性。结果58例患者中39例经活检或病理确诊为恶性肿瘤，DNA定量分析的阳性率（92．31％，36／39）明显高于液基细胞学（82．05％，32／39），差异有统计学意义（ P＝0．017）。DNA定量分析、液基细胞学与组织病理诊断一致性检验Kappa值为分别为0．807、0．498。二者联合检测诊断恶性腹腔积液的曲线下面积（ AUC）为0．92，高于两种单项检测（0．90、0．75）。 DNA定量分析和液基细胞学检测敏感性分别为94．74％（36／38）和84．21％（32／38），特异性分别为85．00％（17／20）和65．00％（13／20），诊断准确性为91．38％（53／58）、77．59％（45／58）；二者联合检测的敏感性为94．87％（37／39），特异性为95．00％（19／20），诊断准确性为93．10％（54／58）。结论 DNA定量分析对腹腔积液诊断的敏感性和特异性明显高于液基细胞学，将两种方法相结合可提高对恶性腹腔积液诊断的准确性。

Objective To discuss the application value of DNA quantitative analysis and thinprep cyto?logic test for the diagnosis of malignant peritoneal effusion. Methods Fifty?eight cases patients with pleural ef?fusion and ascites in the Second People′s Hospital of Yueyang were involved in this study. DNA quantitative a?nalysis and thinprep cytologic test were conducted for the collected ascites,than compared the sensitivity of that two methods. Results There were 39 cases patients were diagnose malignant tumor by biopsy or pathology,the positive rate of DNA quantitative analysis( 92. 31%,36/39) was obviously higher than that of thinprep cytologic test(82. 05%,32/39),the results had no statistical significance(P=0. 017). The consistency check kappa value of DNA quantitative analysis and Thinprep cytologic test with pathology diagnosis were 0. 807 and 0. 498 respec?tively. The AUC of the combined examination of DNA quantitative analysis and thinprep cytologic test for malig?nant peritoneal effusion was 0. 92,higher than the AUC of DNA quantitative analysis and Thinprep cytologic test single index examinations( 0. 90,0. 75) . The detection sensitivity of DNA quantitative analysis and thinprep cyto?logic test were 94. 74%( 36/38 ) and 84. 21%( 32/38 ) respectively, specificity were 85. 00%( 17/20 ) and 65. 00%( 13/20) respectively,the dia were 91. 38%( 53/58) ,77. 59%( 45/58) respectively,the joint detection sensitivity was 94. 87%( 37/39 ) , specificity was 95. 00%( 19/20 ) , the diagnostic accuracy was 93. 10%(54/58). Conclusion Compared with thinprep cytologic test,DNA quantitative analysis with high sensitivity and specificity,while the combination of the two methods can greatly improve the accuracy of diagnosis of malig?nant ascites.