免疫细胞化学和形态学定量分析鉴别胸腹水良恶细胞的意义

目的:探讨免疫细胞化学和形态学分析在胸腹水细胞学鉴别诊断中的意义. 方法: 良恶性胸腹水各30例,应用免疫细胞化学SP法检测癌胚抗原(CEA)、上皮膜抗原(EMA)、波形蛋白(vimentin)的表达,并应用计算机图像分析系统定量测定其脱落细胞的核面积、浆面积、核浆比、细胞周长、平均直径、圆度和形状因子. 结果: 恶性胸腹水中腺癌细胞(B组)CEA表达均阳性,EMA部分阳性,vimentin均阴性;增生性间皮细胞(A组)EMA和vimentin部分阳性,CEA均阴性. 腺癌细胞的核面积、浆面积、核浆比、细胞周长、平均直径和形状因子高于增生性间皮细胞(P＜0.05), 两组间细胞圆度无统计学差异(P＞0.05). 结论: 免疫细胞化学在良恶性胸腹水鉴别诊断中有重要作用, 形态学定量分析可提供参考, 二者综合分析是提高胸腹水细胞学阳性诊断率的有效途径之一.

Values of immunocytochemical and quantitative morphometric analyses in cytological differential diagnosis of pleural and peritoneal effusion

AIM: To explore the values of immunocytochemical and quantitative morphometric analyses in the cytological differential diagnosis of pleural and peritoneal effusion. METHODS: SP immunocytochemical technique was used to detect the expressions of carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA) and vimentin in 30 cases of benign or malignant pleural and peritoneal effusion. Nuclear and cytoplasmic area, nucleus/cytoplasm ratio, cell perimeter, mean diameter, cell roundness and shape were examined by computer-assisted image analysis system. RESULTS: In malignant pleural and peritoneal effusion CEA was all positively expressed, EMA was partly positive, and vimentin was all negative. But in hyperplastic mesothelial cells CEA was all negative,EMA and vimentin were partly positive. The morphometric parameters detected in malignant group were significantly higher than those detected in benign group (P< 0.05), and the cell roundness did not have significant difference (P>0.05). CONCLUSION: Immunocytochemistry technique is of important significance in cytological differential diagnosis of pleural and peritoneal effusion, and morphometry works as a reference. It is effective to combine the 2 kinds of analyses toge- ther for promoting the positive diagnosis rate.