胸腹水脱落细胞流式细胞法DNA倍体分析的临床诊断价值

目的 探讨胸腹水脱落细胞流式细胞法DNA倍体分析对诊断良恶性胸腹水的临床价值.方法 应用流式细胞仪(FCM)对84例患者(恶性肿瘤组35例,非恶性肿瘤组49例)的胸腹水脱落细胞进行DNA倍体分析;以检出异倍体为恶性肿瘤判断标准,并与胸腹水常规脱落细胞学涂片检查结果比较.结果 (1)恶性肿瘤组25例检出异倍体,阳性检出率为71.4%;常规细胞学法20例检出癌细胞,阳性检出率为57.1%;FCM法与细胞学检查法联合检测28例阳性,检出率为80%.(2)在恶性肿瘤组的25例异倍体中,17例病理检查检出癌细胞,8例未检出;而在20例常规细胞学检出癌细胞的患者中,3例DNA倍体分析无异常.(3)非恶性肿瘤组8例DNA表现为异倍体峰,但病理检查示间皮细胞活跃增殖,或未检出癌细胞.结论 FCM法的灵敏度较脱落细胞法高,但2种方法的检测结果存在一定的差异;FCM-DNA倍体分析在良恶性胸腹水的鉴别诊断上尤其当临床高度可疑而病理无法定性时,可作为诊断的重要参考与补充.

Significance of DNA Ploid Analysis of the Exfoliated Cell of Benign and Malignant Hydrothorax and Ascites with Flow Cytometry

Objective To explore the applied value of the flow cytometric(FCM) of DNA ploid analysis for the diagnosis of the exfoliated cell of malignant hydrothorax and ascites. Methods The exfoliated cells from 84 cases hydrothorax and ascites(including 35 cases of malignant tumor group and 49 cases of non-tumor group) were analyzed in DNA ploid by FCM, the results were compared with the method of exfoliative cytology. The presence of aneuploid was used as diagnositic criterion of malignant hydrothorax and ascites. Results In 35 cases malignant tumor group, the detection rate by FCM was 71.4%(25/35) and 57.1%(20/35) by exfoliative cytology. Combined the two methods, the detection rate was 80%(28/35). Among 25 cases from malignant tumor group who presented DNA aneuploid, the carcinoma cells were detected by pathology in 17 cases. 3 cases with positive pathologic detection presented normal DNA ploid. In non-tumor group, the active proliferative mesothelioma cell were found in 8 cases who presented DNA aneuploid. FCM-DNA method was more sensitive than cell pathologic method, but there were some differences between the two methods. Conclusion The analysis of the DNA aneuploid has high diagnostic value for differentiation of the benign and malignant hydrothorax and ascites. It can be a valuable adjunctive method in the pathologic diagnosis.