胸腔积液细胞块免疫组化染色的病理诊断价值

目的探讨细胞块切片免疫组化染色对胸腔积液病理诊断与鉴别诊断的应用价值。方法收集78例患者胸腔积液,分别行常规细胞涂片和细胞块切片,HE染色观察细胞的形态特点,免疫组化S-P法检测CK7、MOC-31、CD15、BerEP4、CEA、TTF-1、CK5/6、Calretinin、WT-1和Desmin的表达,筛选肺腺癌和间皮病变鉴别诊断相关的免疫标记组合。分析临床与随访资料与不同细胞学诊断方法结果之间的差异。结果细胞块制片阳性检出率高于常规细胞涂片,二者HE染色对胸腔积液细胞阳性检出率无显著性差异(P>0.05)。细胞块免疫组化明显优于单纯细胞涂片,二者比较具有显著差异性(χ2=4.17,P<0.01),其对恶性胸腔积液的分型诊断符合率达97.2%,组合性抗体检测显示,肺腺癌中CK7、MOC-31、CD15、BerEP4、CEA、TTF-1呈高表达,间皮病变显示CK5/6、Calretinin、WT-1、Desmin高表达。结论胸腔积液细胞块对诊断恶性胸腔积液具有一定的价值,结合免疫组化选择适当的抗体组合对肺腺癌和恶性间皮瘤的鉴别诊断具有一定的意义,值得临床推广应用。

Significance of cell block immunohistochemistry in diagnosis of pleural effusions

Objective To compare the difference between cell smear and cell block in differential diagnosis of pleural effusions,and to investigate the methods for differential diagnosis between lung adenocarcinoma and malignant mesothelioma.Methods Seventy-eight cases of pleural effusions were examined using cell smear and cell block,respectively.Cell morphology was observed by HE staining.Expression of CK7,MOC-31,CD15,BerEP4,CEA,TTF-1,CK5/6,calretinin,WT-1 and desmin were detected by SP immunohistochemical assay.The association of clinical and follow-up data with different cytology diagnostic methods was analyzed.Results The positive detection rate of the cell block was higher than that of the cell smear,but the positive detection rate by HE staining showed no significant difference between the two methods.The accordance rate of the cell block immunohistochemistry for the diagnosis of malignant pleural effusion was 46.2%,which was significantly higher than that of the cell smear(Chi-square=4.17,P<0.01).CK7,MOC-31,CD15,BerEP4,CEA and TTF-1 were highly expressed in lung adenocarcinoma,whereas CK5/6,calretinin,WT-1 and desmin were highly expressed in malignant mesothelioma and mesothelial reactive hyperplasia.Conclusion Cell block has a certain diagnostic value for malignant pleural effusion,and its combination with immunohistochemistry and complex antibodies is helpful for the differential diagnosis between lung adenocarcinoma and malignant mesothelioma.