细胞蜡块在免疫细胞化学和分子病理中的应用价值

目的探讨浆膜腔积液细胞蜡块在免疫细胞化学和分子病理技术中的应用价值。方法1191例浆膜腔积液均制作细胞蜡块,细胞蜡块切片中发现非典型细胞、可疑恶性肿瘤细胞或典型恶性肿瘤细胞的,将进一步进行免疫细胞化学染色鉴别细胞良恶性、识别病变细胞的组织来源,必要时行分子病理检测,指导临床靶向治疗。结果1191例浆膜腔积液中,检出恶性肿瘤356例,肿瘤原发灶来源以肺癌为主,占56.18%(200/356);病理类型以腺癌为主,占86.80%(309/356)。细胞蜡块切片诊断为Ⅰ级者710例,Ⅱ级者131例,Ⅲ级者210例,Ⅳ级者140例,特异度为91.01%,敏感度为96.89%。细胞蜡块免疫组化检测诊断为Ⅰ级者125例,Ⅱ级及Ⅲ级者均为0,Ⅳ级者356例,其敏感度及特异度均为100%。细胞蜡块免疫组化检测总准确率为100%(481/481),高于细胞蜡块切片的总准确率95.13%(1133/1191),两者相比差异有统计学意义(χ²=7.81,P<0.05)。46例肺腺癌及15例乳腺癌行分子病理检测,肺腺癌EGFR基因突变阳性率为32.6%(15/46),ALK基因重排阳性率为10.8%(5/46),乳腺癌HER?2基因扩增阳性率为40%(6/15)。结论细胞蜡块是鉴别浆膜腔积液的良恶性、判断肿瘤细胞组织来源及病理类型的有效载体,同时亦可作为分子病理检材,对后续精准治疗具有重要的临床应用价值。

Application value of cell wax block in immunocytochemistry and molecular pathology

Objective To explore the application value of cell wax block of serous cavity effusion in immunocytochemistry and molecular pathology.Methods Cell wax block was prepared in 1191 cases of serous cavity effusion,and immunocytochemical staining was used to identify the tissue source of diseased cells based on the results of paraffin section of the sediment;molecular pathology testing was conducted when necessary for guiding clinical targeted therapy.Results Among the 1191 cases of serous effusion,356 cases of malignant tumors were detected.The primary source of the tumor was mainly lung cancer,accounting for 56.18%(200/356);the pathological type was mainly adenocarcinoma,accounting for 86.80%(309/356).Cell wax sections were diagnosed as grade I in 710 cases,grade II in 131 cases,grade III in 210 cases,and grade IV in 140 cases,in which the specificity was 91.01%and the sensitivity was 96.89%.Cell wax block immunohistochemical detection was diagnosed in 125 cases with grade I,0 in grades II and III,and 356 in grade IV,in which the sensitivity and specificity were both 100%.The total accuracy rate of cell wax block immunohistochemical detection was 100%(481/481),which was higher than the accuracy rate of cell wax block section by 95.13%(1133/1191).The difference between the two was statistically significant(χ²=7.81,P<0.05).46 cases of lung adenocarcinoma and 15 cases of breast cancer were examined by molecular tests.The positive rate of EGFR gene mutation in lung adenocarcinoma was 32.6%(15/46),and the positive rate of ALK gene rearrangement was 10.8%(5/46).In breast cancer the positive rate of HER-2 gene amplification was 40%(6/15).Conclusion Cell wax block is an effective carrier for distinguishing benign and malignant serous cavity effusion,judging the source of tumor cell tissue and pathological type.It can also be used as a molecular pathology sample and has important clinical application value for further precision treatment.