肺癌胸腔冲洗液中脱落癌细胞诊断及鉴别诊断的研究

目的探讨免疫细胞化学检查在肺癌胸腔冲洗液中对脱落癌细胞鉴别诊断的价值，确定适用于胸腔冲洗液检查的最佳抗体和检查方法。方法对62例肺癌患者的胸腔冲洗液沉渣涂片行两种常规染色：HE染色、Papanicolaou染色；同时行链霉素菌抗生物素蛋白-过氧化物酶法染色（SP），单克隆抗体为：癌胚抗原（CEA）、上皮抗原（EA）、间皮细胞（MC）、波形蛋白（Vimentin）。将结果与细胞学诊断进行比较。结果62例肺癌患者胸腔冲洗液细胞学诊断阳性28例（阳性组），可疑6例（可疑组），阴性28例（阴性组）。确诊腺癌细胞CEA、EA、MC、Vimentin的阳性表达率分别为：阳性组中92．00％、92．00％、12．00％、44．00％；可疑组75．00％、100．00％、0、25．00％；阴性（细胞学诊断）组66．66％、100．00％、0、33．33％。免疫细胞化学染色检测优于常规细胞学检查，差异有统计学意义（x2=4，P〈0．05）。结论联合应用CEA、EA、MC、Vimentin进行免疫细胞化学检查对鉴别胸腔脱落癌细胞与反应性间皮细胞具有一定的临床价值。

Diagnosis and Differential Diagnosis Research of Caducous Cancer Cells in Thoracic Cavity Douche in Patients with Lung Cancer

Objective To explore the differential diagnosis value of immunocytochemical examination to caducous cancer cell in thoracic cavity douche in lung cancer patients. The cytological and immunocytochemical examinations were performed using four monoclonal antibodies combined with hematoxylin, eosin staining （HE） and Papanicolaou staining. Meanwhile, the optimal antibody and examination methods suitable for thoracic cavity douche were determined and experiment evidence for clinical application was provided. Methods Two routine stain methods-HE staining and Papanicolaou staining were conducted to the film preparation of thoracic cavity douche deposits from 62 lung cancer patients. Meanwhile, streptomycin avidin - peroxidase enzyme staining （SP） was performed with CEA, EA, MC and Vimentin as four monoclonal antibodies. Buffy or dark brown colour in plasma membrane or cytoplasm was taken as positive cells. Results Cytological examination of thoracic cavity douche deposits form 62 lung cancer patients, 28 positive cases （positive group）, 6 doubtful cases （doubtful group） , 28 negative cases （negative group）. The positive expression ratio of CEA, EA, MC, Vimentin in cells of lung cancer thoracic cavity douche were 92.00% , 92.00% , 12.00% , 44.00% for adenocarcinoma cells in the positive group; 75.00% , 100.00% , 0, 25.00% in the doubtful group; and negative rates of 66.66%, 100.00% , 0, 33.33% in cytologic diagnosis group. ICC is superior to cytological examination with significant difference （X2 = 4, P 〈 0. 05）. Conclusion The union of CEA, EA, MC, Vimentin for immunocytoehemistry examination has some clinical ap-plication value as it can identify caducous cancer cells of thoracic cavity with reactivity mesothelial ceils.