免疫细胞化学在浆膜腔积液细胞学诊断中的应用——附75例分析

目的解决浆膜腔积液中疑难病例的确诊、分型，探讨ＩＣＣ在积液中鉴别诊断的价值，找出适于这项诊断的最佳抗体。方法选用６种单克隆抗体（ＥＭＡ、ＣＥＡ、ＣＤ１５、ＣＫ１７、ＣＫ１８、ｖｉｍｅｎｔｉｎ）对７５例积液标本进行诊断。ＨＥ用双盲法比较诊断结果。结果在７５例积液中，ＨＥ诊断阴性２１例，可疑１０例，恶性４４例。ＩＣＣ鉴别出恶性积液５４例，反应性积液２１例。结论ＨＥ结合ＩＣＣ检查可提高阳性诊断率。ＥＭＡＣＥＡ、ｖｉｍｅｎｔｉｎ联合应用可从正反两方面同时证明癌细胞的存在，是积液中ＩＣＣ的最佳抗体组合。ＣＫ１７、ＣＫ１８对鉴别积液中鳞癌、腺癌有参考价值。ＣＤ１５有助于积液中原发性肺腺癌的鉴别。在细胞学检查中应普遍推广ＩＣＣ。

The Value of Immunocytochemistry in the Cytological Diagnosis of Serous Effusion:An Analysis of 75 Cases

Objective To investigate the value of immunocytochemistry(ICC) in the differential diagnosis of difficult cases with serous effusion in the serous cavity.Methods The immunocytochemical method was utilized for the differential diagnosis and classification of malignant tumor cells in serous effusion. EMA, CEA, CD15, CK17, CK18 and vimentin were selected in the study of 75 cases of serous specimen, and the results were compared with that of HE staining.Results In cases with HE staining, there were 21 cases negative, 10 cases equivocal, 44 cases malignant; while in cases with immunocytochemical examinations, there were 54 cases malignant and 21 cases reactive.Conclusions HE staining combined with ICC method can elevate the positive rate of diagnosis. EMA, CEA, vimentin used in combination are the best antibody's composition for the identification of cancer cells from both negative and positive sides, CD15 is of some help to the diagnosis of primary lung adenocarcinoma in the effusion, and CK17 and CK18 have some reference value in the differentiation of squamous cell carcinoma from adenocarcinoma in the effusion. Therefore, ICC should be widely used in cytological diagnosis.