比较胸腹水常规细胞学和液基细胞学在肿瘤细胞中的研究价值分析
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摘要
目的比较胸腹水常规细胞学和液基细胞学检查(TCT)在肿瘤细胞中的应用价值,以期提高细胞学检查阳性率,为临床诊治提供依据。方法选取2016年2月-2018年4月本院收治的108例疑似肿瘤患者,均接受TCT和胸腹水常规检查。统计组织病理学诊断结果,对比TCT与胸腹水常规细胞学检查结果。结果以组织病理学诊断为金标准108例疑似肿瘤患者,确诊65例恶性肿瘤,43例良性肿瘤。65恶性肿瘤患者包含27例腹水,38例胸水;恶性肿瘤类型以腺癌为主,其次为未分化癌、鳞癌。以组织病理学诊断为金标准。胸腹水常规细胞学检查确诊64例恶性肿瘤,44例良性肿瘤,13例漏诊,12例误诊。以组织病理学诊断为金标准。TCT确诊64例恶性肿瘤,44例良性肿瘤,2例漏诊,1例误诊。TCT诊断符合率、特异度、敏感度分别为97.22%、97.67%、96.92%,高于胸腹水常规细胞学诊断结果(76.85%、72.09%、80.00%),且Kappa指数大于胸腹水常规细胞学诊断结果,差异有统计学意义(P<0.05)。结论与胸腹水常规细胞学检查比较,TCT在胸腹水恶性肿瘤细胞鉴别诊断中具有较高诊断价值,能获得良好制片效果和准确诊断结果,为临床确定后续治疗方案提供依据,可作为肿瘤早期筛查的手段之一,值得临床推广及应用。
Objective To compare the application value of routine cytology and liquid-based cytology(TCT) of pleural and ascites in tumor cells, in order to improve the positive rate of cytology and provide basis for clinical diagnosis and treatment. Methods A total of 108 patients with suspected tumors admitted to our hospital from February 2016 to April 2018 were enrolled in the routine examination of TCT and ascites. The results of statistical histopathological diagnosis were compared, and the results of routine cytology of TCT and ascites were compared. Results Histopathological diagnosis was the gold standard. Of the 108 patients with suspected tumors, 65 were diagnosed with malignant tumors and 43 were benign tumors. 65 patients with malignant tumors included 27 cases of ascites and 38 cases of pleural effusion; the type of malignant tumor was mainly adenocarcinoma, followed by undifferentiated carcinoma and squamous cell carcinoma. With histopathological diagnosis as the gold standard, routine cytology of chest and ascites confirmed that 64 cases had malignant tumors, 44 cases had benign tumors, 13 cases were missed diagnosis, and 12 cases were misdiagnosed. With histopathological diagnosis as the gold standard, TCT diagnosed 64 malignant tumors, 44 benign tumors, 2 missed diagnosis and 1 misdiagnosis. The diagnostic coincidence rate(97.22%), specificity(97.67%) and sensitivity(96.92%) of TCT were higher than the results of conventional cytological diagnosis of chest and abdomen water(76.85%, 72.09% and 80.00%), and Kappa index was higher than that of conventional cytological diagnosis of chest and abdomen water, with the differences statistically significant(P<0.05). Conclusion Compared with conventional cytological examination of pleural and abdominal water, TCT had a higher diagnostic value in the differential diagnosis of malignant tumor cells in chest and abdomen, which can obtain good film-making effect and accurate diagnostic results, and provide basis for clinical determination of follow-up treatment program, so it can be used as one of the means of early tumor screening, and is worthy of clinical promotion and application.
Objective To compare the application value of routine cytology and liquid-based cytology(TCT) of pleural and ascites in tumor cells, in order to improve the positive rate of cytology and provide basis for clinical diagnosis and treatment. Methods A total of 108 patients with suspected tumors admitted to our hospital from February 2016 to April 2018 were enrolled in the routine examination of TCT and ascites. The results of statistical histopathological diagnosis were compared, and the results of routine cytology of TCT and ascites were compared. Results Histopathological diagnosis was the gold standard. Of the 108 patients with suspected tumors, 65 were diagnosed with malignant tumors and 43 were benign tumors. 65 patients with malignant tumors included 27 cases of ascites and 38 cases of pleural effusion; the type of malignant tumor was mainly adenocarcinoma, followed by undifferentiated carcinoma and squamous cell carcinoma. With histopathological diagnosis as the gold standard, routine cytology of chest and ascites confirmed that 64 cases had malignant tumors, 44 cases had benign tumors, 13 cases were missed diagnosis, and 12 cases were misdiagnosed. With histopathological diagnosis as the gold standard, TCT diagnosed 64 malignant tumors, 44 benign tumors, 2 missed diagnosis and 1 misdiagnosis. The diagnostic coincidence rate(97.22%), specificity(97.67%) and sensitivity(96.92%) of TCT were higher than the results of conventional cytological diagnosis of chest and abdomen water(76.85%, 72.09% and 80.00%), and Kappa index was higher than that of conventional cytological diagnosis of chest and abdomen water, with the differences statistically significant(P<0.05). Conclusion Compared with conventional cytological examination of pleural and abdominal water, TCT had a higher diagnostic value in the differential diagnosis of malignant tumor cells in chest and abdomen, which can obtain good film-making effect and accurate diagnostic results, and provide basis for clinical determination of follow-up treatment program, so it can be used as one of the means of early tumor screening, and is worthy of clinical promotion and application.
引文
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[10] 郭周庆, 吴又明, 王红霞, 等. 细胞形态学对鉴别良恶性胸腹水的临床价值[J].检验医学与临床, 2015, 12(11): 1528-1529.
[11] 葛德芹, 丁玉江, 赵霞,等. 液基超薄细胞术在恶性胸腔积液诊断中的意义[J]. 临床肺科杂志, 2017, 22(11): 2125-2126.
[12] 王晓光, 辛志峰, 李娜, 等. 人乳头瘤病毒检测与薄层液基细胞学技术在宫颈癌筛查中的应用[J]. 现代妇产科进展, 2016, 25(2): 140-142.
[13] 禹乐, 孟加榕, 朱启淦, 等. 液基薄层细胞涂片在胸腹水诊断中的应用价值[J].山西医科大学学报, 2017, 48(2): 149-152.
[14] 傅春玲, 刘定荣, 吴彤, 等. 液基细胞学及细胞蜡块联合免疫细胞化学检测在胸腹水细胞病理诊断中的临床价值[J]. 重庆医学, 2018, 47(8): 1058-1060.
[2] 郭守俊, 曾红学, 刘联斌, 等. 肿瘤细胞学、DNA异倍体和肿瘤标志物检测在良恶性胸腔积液鉴别诊断中的临床价值[J]. 实用癌症杂志, 2016, 31(4): 681-682.
[3] Luo J, Wang M, Li C, et al. A novel combination of calprotectin and CXCL12 for predicting malignancy in patients with exudative pleural effusion[J]. Medicine (Baltimore), 2015, 94(47): e2105.
[4] 杨倩. 脱落细胞学检查、DNA 倍体分析与血清肿瘤标志物联合检测诊断恶性胸腹水的价值[J]. 蚌埠医学院学报, 2015, 40(8): 1046-1048.
[5] 王应霞, 张旋, 吴莹莹, 等. 液基细胞学检测联合DNA倍体分析在良恶性胸腹水鉴别诊断中的应用[J]. 临床与实验病理学杂志, 2016, 32(10): 1152-1155.
[6] Saiphoklang N, Kanitsap A, Nambunchu A, et al. Differences in clinical manifestations and pleural fluid charateristics between tuberculous and malignant pleural pleural effusions[J]. Southeast Asian J Trop Med Public Health, 2015, 46(3): 496-503.
[7] 张华, 李伟. 加味十枣汤联合胸腔循环灌注热化疗治疗恶性肿瘤胸腔积液疗效观察[J].河北医药, 2016, 38(22): 3455-3456.
[8] 刘芳, 何欣, 李晓琴, 等. 免疫组化标志物在鉴别浆膜腔积液恶性肿瘤细胞中的应用价值[J]. 临床与实验病理学杂志, 2018, 34(2): 201-204.
[9] 尤志群, 顾冬梅, 虞杰, 等. 恶性胸腹水细胞块免疫组化检查的应用价值[J]. 江苏医药, 2016, 42(6):727-728.
[10] 郭周庆, 吴又明, 王红霞, 等. 细胞形态学对鉴别良恶性胸腹水的临床价值[J].检验医学与临床, 2015, 12(11): 1528-1529.
[11] 葛德芹, 丁玉江, 赵霞,等. 液基超薄细胞术在恶性胸腔积液诊断中的意义[J]. 临床肺科杂志, 2017, 22(11): 2125-2126.
[12] 王晓光, 辛志峰, 李娜, 等. 人乳头瘤病毒检测与薄层液基细胞学技术在宫颈癌筛查中的应用[J]. 现代妇产科进展, 2016, 25(2): 140-142.
[13] 禹乐, 孟加榕, 朱启淦, 等. 液基薄层细胞涂片在胸腹水诊断中的应用价值[J].山西医科大学学报, 2017, 48(2): 149-152.
[14] 傅春玲, 刘定荣, 吴彤, 等. 液基细胞学及细胞蜡块联合免疫细胞化学检测在胸腹水细胞病理诊断中的临床价值[J]. 重庆医学, 2018, 47(8): 1058-1060.