Calretinin、CEA标记在胸腹腔积液细胞学诊断中的应用

目的：探讨calretinin、CEA免疫细胞化学标记对浆膜腔积液中正常、反应性间皮细胞与转移性癌细胞的鉴别诊断价值。方法：59例胸腹腔积液标本，采用常规：HE染色、CEA及calretinin免疫细胞化学标记。最后诊断通过活检、随访等确立。结果：最后诊断转移癌17例、良性者37例、未确定5例。Calretinin对间皮细胞标记的阳性率为94．6％(35／37)86.5％(32／37)，强阳性]，转移癌细胞23．5％(4／17)阳性5．9％(1／17)强阳性]；CEA对转移癌细胞标记的阳性率为88．4％(15／17)52．9％(9／17)强阳性]，良性间皮细胞43．2％(16／37)阳性13．5％(5／17)强阳性]。17例转移癌中，11例calretinin、CEA两项标记支持转移癌诊断；良性组中，CEA标记有较多假阳性。结论：CEA的特异性相对较差，calretinin对间皮细胞标记的特异性、敏感性较高。结果判定时，强阳性结果较弱阳性结果有意义，calretinin结果较CEA更有价值。认真细致的形态学观察，辅以calretinin及CEA标记，可有效地避免假阳性诊断。

Application of calretinin and CEA immunocytochemical label in serous effusion cytology

Purpose:To investigate the value of immunocytochemistry in the differential diagnosis of normal and reactive mesothelial cells versus metastatic carcinoma cells in serous effusions.Methods:59 effusion specimens were immunostained using antibodies against calretinin and CEA. HE staining was also performed. The definitive diagnoses were made depending on biopsies.Results:Of 59 cases, 37 cases were benign, 5 cases undetermined, 17 cases malignant. Positive immunoreaction for calretinin in normal and reactive mesothelial cells was noted in 94.6%(86.5% strong positive) of cases, whereas 23.5%(5.9% strong positive) of metastatic carcinoma cells expressed calretinin. Metastatic carcinoma cells were detected with anti CEA in 88.4%(52.9% strong positive) of malignant effusions. 43.2%(13.5% strong positive) of benign effusions had positive immunoreaction with CEA. In 11 cases of 17 metastatic carcinomas, the immunoreaction for calretinin and CEA was concordant with the final diagnoses. There were more false positive immunoreactions for CEA in normal and reactive mesothelial cells. Conclusions:Our results demonstrate high sensitivity and specificity of anti calretinin antibody for mesothelial cells in effusion specimens. CEA shows limited sensitivity and specificity. Calretinin label was more valuable than CEA. Strong positive reaction was more significant than weak positive reaction. Calretinin label could be helpful in the assessment of false positive reactions of CEA. When the assessment combined morphologic features with calretinin and CEA, false positive diagnoses were avoided.