联合检测B72.3、癌胚抗原、神经特异性钙结合蛋白、血栓素在浆膜腔积液细胞学鉴别诊断中的价值

目的探讨B72.3、癌胚抗原、神经特异性钙结合蛋白、血栓素组合检测在浆膜腔积液中恶性间皮瘤和增生间皮细胞与腺癌鉴别诊断的价值。方法取123例浆膜腔积液,经活检或临床资料证实为转移腺癌89例、恶性间皮瘤8例、增生间皮细胞26例,并对细胞学标本做特殊处理后常规涂片,做B72.3、癌胚抗原、神经特异性钙结合蛋白、血栓素免疫细胞化学与苏木素-伊红(HE)染色分析。结果123例积液标本中,B72.3、癌胚抗原诊断腺癌的敏感性分别为80.1%、78.7%,特异性分别为97.1%、97.1%,B72.3、癌胚抗原组合检测诊断转移腺癌的敏感性为95.5%(85/89);神经特异性钙结合蛋白、血栓素诊断间皮源性细胞敏感性分别为88.2%、79.4%,特异性分别为95.5%、91.0%,神经特异性钙结合蛋白、血栓素组合检测诊断间皮源性细胞敏感性为94.1%(32/34),其中恶性间皮瘤为100%(8/8)。结论通过对浆膜腔积液细胞学标本的有效处理和制片技术的改进,选择B72.3、癌胚抗原、神经特异性钙结合蛋白、血栓素组合检测和细致的细胞形态学观察,可进一步提高浆膜腔积液中恶性间皮瘤与转移性腺癌的鉴别诊断。

Value of combining detection of B72.3,carcinoembryonic antigen,calretinin and thromboxane in cytological differential diagnosis of serous effusion

Objective To explore the value of combining detection of B72.3,carcinoembryonic antigen,calretinin and thromboxane in cytological differential diagnosis of serous effusion. Methods A total of 123 effusion cytology specimens from 89 cases of metastatic adenocarcinoma,8 cases of malignant mesothelioma,and 26 cases of mesothelium were collected.All cases were confirmed histologically or clinically.Materials from all cases were prepared in hematoxylin and eosin(HE) staining smears,and cell blocks,immunocytochemical staining was performed on cell block sections. Results For metastatic adenocarcinoma,the diagnostic sensitivity of B72.3 and carcinoembryonic antigen was 80.1% and 78.7% respectively,the diagnostic specificity was 97.1% and 97.1% respectively.If B72.3 and carcinoembryonic antigen were considered together,the positive rate was 95.5%(85/89).The sensitivity of calretinin and thromboxane in diagnosing malignant mesothelioma and reactive mesothelium was 88.2% and 79.4% respectively,the specificy was 95.5% and 91.0% respectively.If calretinin and thromboxane were considered together,the positive rate was 94.1%(32/34) and the positive rate of malignant mesotheliome was 100%(8/8). Conclusions The combination of B72.3,CEA,calretinin and thromboxane is a very useful panel in cytological differential diagnosis for metastatic adenocarcinoma and mesothelial cells in serous effusion.