DNA定量细胞学检查联合液基细胞学检测在胸腔积液鉴别诊断中的应用
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摘要
目的研究DNA定量细胞学检查联合液基细胞学检测在鉴别良恶性胸腔积液中的应用价值。方法收集2015年1月-2017年12月我院73例胸腔积液患者,对其胸腔积液进行DNA定量细胞学检查和液基细胞学检测。结果 DNA定量细胞学检查的灵敏度(78.9%)高于液基细胞学检测(68.4%),差异有统计学意义(P<0.05)。液基细胞学检测的特异度(100%)明显高于DNA定量细胞学检查(82.9%),差异有统计学意义(P<0.05)。二者联合检测诊断胸腔积液的曲线下面积(AUC)为0.921,高于DNA定量细胞学检查(0.809)和液基细胞学检测(0.842)。联合检测的阳性预测值、阴性预测值、阳性似然比、阴性似然比及诊断准确度分别为84.2%、82.9%、4.91、0.226和67.1%,均优于DNA定量细胞学检测;液基细胞学检测的阳性预测值(100%)优于联合检测,但阴性预测值(74.5%)及诊断准确度(31.6%)不及联合检测。结论胸腔积液DNA定量细胞学检查和液基细胞学检测有较高的灵敏度和特异度,联合检测可提高对恶性胸腔积液诊断的准确性。
Objective To assess the diagnostic value of DNA heteroploid detection and thinprep cytologic test(TCT) between malignant and benign pleural effusion. Methods We collected 73 cases of pleural effusions from January 2015 to December 2017 in our hospital. All the patientsʼ pleural effusion were detected by DNA heteroploid detection and TCT. Results The sensitivity of DNA heteroploid detection(78.9%) was higher than TCT(68.4%), and the difference was statistically significant(P<0.05). The specificity of TCT(100%) was significantly higher than DNA heteroploid detection(82.9%)(P<0.05). The area under the curve(AUC) for the combined detection was 0.921, which was higher than that of DNA heteroploid detection(0.809) and liquid-based cytology(0.842). The positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic accuracy of the combined detection were 84.2%, 82.9%, 4.91, 0.226 and 67.1% respectively, which were superior to those of DNA heteroploid detection. The positive predictive value(100%) of TCT was superior to that of the combined detection, but the negative predictive value(74.5%) and diagnostic accuracy(31.6%)were not as good as combined detection. Conclusion The pleural effusion DNA heteroploid detection and TCT have higher sensitivity and specificity, and combined detection can improve the accuracy of the diagnosis of malignant pleural effusion.
Objective To assess the diagnostic value of DNA heteroploid detection and thinprep cytologic test(TCT) between malignant and benign pleural effusion. Methods We collected 73 cases of pleural effusions from January 2015 to December 2017 in our hospital. All the patientsʼ pleural effusion were detected by DNA heteroploid detection and TCT. Results The sensitivity of DNA heteroploid detection(78.9%) was higher than TCT(68.4%), and the difference was statistically significant(P<0.05). The specificity of TCT(100%) was significantly higher than DNA heteroploid detection(82.9%)(P<0.05). The area under the curve(AUC) for the combined detection was 0.921, which was higher than that of DNA heteroploid detection(0.809) and liquid-based cytology(0.842). The positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and diagnostic accuracy of the combined detection were 84.2%, 82.9%, 4.91, 0.226 and 67.1% respectively, which were superior to those of DNA heteroploid detection. The positive predictive value(100%) of TCT was superior to that of the combined detection, but the negative predictive value(74.5%) and diagnostic accuracy(31.6%)were not as good as combined detection. Conclusion The pleural effusion DNA heteroploid detection and TCT have higher sensitivity and specificity, and combined detection can improve the accuracy of the diagnosis of malignant pleural effusion.
引文
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[12]薛秋婷,顾兵,朱立强.液基细胞学联合免疫细胞化学对疑难肺腺癌转移胸腔积液的诊断价值[J].临床与病理杂志,2016,36(12):1938-1943.
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[15]KASHYAP V,BHAMBHANI S.DNA aneuploidy in invasive carcinoma of the uterine cervix[J].Indian J Pathol Microbiol,2000,43(3):265-269.
[2]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.
[3]王应霞,赵珍,杨梅秋,等.液基细胞学检测在良恶性胸腹水鉴别诊断中的应用[J].昆明医科大学学报,2016,37(4):45-48.
[4]胡艳萍,贺兰湘,于丁,等.非小细胞肺癌细胞DNA含量与其生物学行为关系的初步研究[J].中华肿瘤杂志,2003,25(1):55-58.
[5]BARLOGIE B,RABER M N,SCHUMANN J,et al.Flow cytometry in clinical cancer research[J].Cancer Res,1983,43(9):3982-3997.
[6]何敏,邝军,朱建勇,等.痰细胞学联合支气管镜DNA倍体检测对肺癌的诊断意义[J].临床肺科杂志,2014,19(4):710-712.
[7]马述春,姜玮,王彤瑶.诱导痰脱落细胞TCT联合DNA定量分析[J].现代诊断与治疗,2013,24(1):47-48.
[8]MENG Z,SHI J,ZHU C,et al.Automated quantification of DNAaneuploidy by image cytometry as an adjunct for the cytologic diagnosis of malignant effusion[J].Anal Cell Pathol(Amst),2013,36(3/4):107-115.
[9]周新,陈宇清.检测DNA异倍体对恶性胸腔积液的诊断价值[J].临床肺科杂志,2001,6(1):1-2.
[10]祁明浩.流式细胞仪DNA倍体测定鉴别良恶性胸腔积液的诊断价值[J].临床肺科杂志,2007,12(7):664,686.
[11]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.
[12]薛秋婷,顾兵,朱立强.液基细胞学联合免疫细胞化学对疑难肺腺癌转移胸腔积液的诊断价值[J].临床与病理杂志,2016,36(12):1938-1943.
[13]黄荣,方先勇,朱立强.液基细胞学对胸腔积液中腺癌诊断及鉴别诊断中的应用价值[J].国际检验医学杂志,2015,36(6):847-848.
[14]陈绍森,邹林,胡佩村,等.细胞DNA倍体分析联合肿瘤特异性生长因子检测对恶性胸腔积液的诊断价值[J].广东医学,2013,34(2):236-237.
[15]KASHYAP V,BHAMBHANI S.DNA aneuploidy in invasive carcinoma of the uterine cervix[J].Indian J Pathol Microbiol,2000,43(3):265-269.