脑脊液肿瘤细胞学检查在视网膜母细胞瘤诊疗中的价值

 目的 探讨脑脊液(cerebrospinal fluid,CSF)肿瘤细胞学检查在视网膜母细胞瘤(retinoblastoma,RB)诊疗中的价值。方法 回顾性分析2010-05至2014-06武警总医院儿科经临床确诊且资料完整的RB患者125例的CSF细胞形态学检查(cytomorphology,CM)和免疫流式细胞术(flowcytometry,FC)结果,并与其临床转归进行对比分析,以总结CSF肿瘤细胞学检查在RB患者诊治中的价值。结果 125例视网膜母细胞瘤患者中,治疗前首次CSF中发现肿瘤细胞的是24例。首次CSF检查发现肿瘤细胞的患者比未发现肿瘤细胞的患者平均生存时间明显缩短(6.4个月 vs 16.0个月,P＜0.05),且病死率明显升高(P＜0.05);治疗前影像学证实转移的患者比仅CSF发现肿瘤细胞的患者平均生存时间明显缩短(3.3个月 vs 8.6个月,P=0.021),但病死率差异无统计学意义(100% vs 81%,P=0.19);脑脊液FC比CM检测敏感性好(P＜0.001)。结论 RB易发生颅内转移且危及患者生命,CSF的肿瘤细胞学检查是早期发现中枢神经系统转移的重要手段,联合应用CM与FC有效提高CSF中肿瘤细胞的检出率。针对CSF中发现肿瘤细胞的患者,应在全身系统化疗的基础上,增加鞘内化疗以降低这部分患者的病死率,延长生存时间。

Value of cerebrospinal fluid cytology examination in diagnosis and treatment of children retinoblastoma

Objective To study the application value of cerebrospinal fluid (CSF) cytology examination in diagnosis and treatment of retinoblastoma. Methods We reviewed the results of CSF cytology examination by cytomorphology (CM) and flow cytometry (FC) for detecting early metastasis of retinoblastoma (RB) during July 2011 to July 2014. 125 cases of CSF cytology examination and prognosis were retrospectively analyzed. Results 125 CSF samples from 125 newly diagnosed RB patients were detected by CM before treatment,24 patients had a positive first sample by initial cytology examination. Patients with positive CSF samples by cytology examination tended to a poorer prognosis than patients with negative first sample. At the time of diagnosis, patients with imaging change of nervous system metastasis tended to a poor survival than patients with positive cytology only at initial samples, mean survival time (3.3 months vs 8.6 months, P=0.021); mortality rate (100% vs 81%, P=0.19). FC retained significantly more sensitivity than that of CM (sensitivity 90% vs 58%,P＜0.01).Conclusions Diagnosis of RB involving CSF with application of CM and FC can improve the detection rate.Havenmore intensive chemotherapy (including system and intrathecal chemotherapy) immediately after diagnosis might be beneficial for timely treating and it also prolonged these patients’ survival.