骨髓印片在骨髓细胞学检验中的应用价值

目的 研究骨髓印片在血液病诊断中的应用价值.方法 收集2002年1月至2008年6月同步骨髓涂片、印片和切片检查的3024例初诊血液系统疾病患者(男1667例,女1357例,年龄7～82岁,中位年龄55岁)的骨髓标本重新阅片,以切片有核细胞量为标准评估印片与涂片的指标性能,并以临床汇总诊断为依据,比较骨髓印片、涂片和切片的诊断符合率.选取79例浸润性淋巴瘤、114例浆细胞骨髓瘤(PCM)患者骨髓标本,对肿瘤细胞在印片与切片中的浸润方式进行等级相关分析.结果 骨髓印片含较明显的造血区和非造血区,细胞基本保留了完整的形态学结构.骨髓印片的有核细胞量评估性能优于涂片(P<0.05)而与切片相近(P>0.05).印片对脾功能亢进(130例)、骨髓转移癌(67例)、伴原始细胞增多难治性贫血(27例)、骨髓增殖性肿瘤(174例)和PCM(94例)的诊断符合率高于涂片(分别为96.9%比80.7%、91.0%比76.1%、92.6%比81.5%、92.5%比76.4%、97.8%比92.6%,均P<0.05),对巨幼红细胞性贫血(69例)、急性髓细胞白血病亚型(104例)、单系和多系增生异常难治性血细胞减少(分别为15例和22例)、淋巴浆细胞性淋巴瘤(12例)的诊断符合率高于切片(分别为100%比84.0%,91.3%比74.0%,86.7%比60.0%,90.9%比72.7%,66.6%比50.0%,均P<0.05),对骨髓增生异常-骨髓增殖性肿瘤(26例)的诊断符合率(96.2%)高于涂片(76.3%,P<0.05)和切片(78.2%,P<0.05).浸润性淋巴瘤与PCM患者骨髓印片和切片中肿瘤细胞浸润方式具有良好的相关性(r=0.90,r=0.78,均P<0.05).结论 骨髓印片兼有涂片和切片的特征.印片评估有核细胞量优于涂片,也可预测切片中肿瘤细胞浸润的某些方式.印片单个核细胞的形态学清晰度优于骨髓切片,对主要依据形态学进行的诊断具有明显优势.

Value of imprint in bone marrow morphological examination

Objective To explore the role of bone marrow (BM) imprint in the diagnosis of hematological diseases.Methods Between January 2002 and June 2008,a total of 3024 cases with BM smears,imprints and sections conducted simultaneously were recruited.There were 1667 males and 1357 females with a median age of 55 years old (range:7 to 92).The cellularity on imprint and smear was evaluated with the standard cellularity on BM section.With the integrative diagnosis (including all examinations and clinical outcomes)88 the standard,the diagnostic accuracy of hematological diseases were compared between BM imprint,smear and section groups.Another 79 cases of lymphoma and 114 cases of plasma cell myeloma (PCM) were selected for a correlation analysis of tumor cell infiltration patterns.Results BM imprint contained hematopoietic and non-hematopoietic regions and cells retained integrated structure.The cellularity evaluation by imprint was superior to smear overall.In BM imprint group,the diagnostic accuracy for hypersplenism (n=130),metastatic carcinoma (n=67),refractory anemia with excess blasts,myeloproliferative neoplasm (n:174),and PCM (n=94) were better than smear group (96.9% vs 80.7%,91.0% vs 76.1%,92.6% vs 81.5%,92.5% vs 76.4%,and 97.8% vs 92.6%respectively,all P<0.05);And the diagnostic accuracy for megaloblastie anemia(n=69),acute myeloid leukemia(n=104),refractory cytopenia with unilineage dysplasia (n=15),refractory cytopenia with muhilineage dysplasia(n=22),and lymphoplasmacytic lymphoma(n=12) were higher than biopsy section group (100% vs 84.0%,91.3% vs 74.0%,86.7% vs 60.0%,90.9% vs 72.7%,and 66.6% vs 50.0%respectively,all P<0.05);And the diagnostic accuracy for myelodysplastic/myeloproliferative neoplasm (n=26) was higher than smear group (76.3%,P<0.05) and biopsy section group (78.2%,P<0.05).Excellent correlations existed between BM imprint and section of the patients with lymphoma or with PCM (r=0.90,r=0.78,both P<0.05).Conclusions BM imprint contains the characteristics of both smear and section.BM imprint is superior to smear for an evaluation of cellularity.And it is also better than section for an analysis of cytological changes.