传统涂片及细胞蜡块+免疫组化对渗出性胸腔积液的诊断价值
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摘要
目的通过分析对比传统涂片及细胞蜡块+免疫组化两种方法在诊断渗出性胸腔积液中有无差异,进而探讨其在临床诊断中的应用价值。方法选取包头医学院第一附属医院144例渗出性胸腔积液标本,采用传统涂片及细胞蜡块+免疫组化两种检查方法,通过显微镜下观察细胞形态及染色情况对渗出性胸腔积液加以诊断,统计分析两种方法在胸腔积液中的统计学差异,推断其在临床应用中的价值。结果传统涂片及细胞蜡块+免疫组化两种方法对于渗出性胸腔积液的诊断中,在恶性胸腔积液中的检出率分别为26例(18.1%)、57例(39.6%),炎性积液检出率分别为103例(71.5%)、87例(60.4%),在可疑恶性中检出率分别为15例(10.4%)、0例(0.0%),差异均具有统计学意义。结论细胞蜡块+免疫组化检查法较传统涂片法在渗出性胸腔积液的诊断中更有优势,尤其在可疑恶性积液中价值更高,不仅可以确定积液性质而且可以判定组织来源,但传统涂片法方法简便、价格优惠,虽有一定的漏诊率但误诊率较低以及实验室要求相对不高更适合临床病人初期的筛查,两种方法联合检查既可提高检出率又可减少不必要的检查,在临床应用中具有很高的价值。
Objective To analyze the comparison between traditional smear and cell wax block + immunohistochemistry in the diagnosis of exudative pleural effusion, and to explore its application value in clinical diagnosis. Methods A total of 144 samples of exudative pleural effusion were obtained from the First Affiliated Hospital of Baotou Medical College. The traditional smear and cell wax block + immunohistochemistry were used to observe the morphology and staining of the exudative thoracic cavity. The effusion was diagnosed, and the statistical difference between the two methods in pleural effusion was statistically analyzed, and its value in clinical application was inferred. Results In the diagnosis of exudative pleural effusion, the detection rates of traditional smear and cell wax block + immunohistochemistry in malignant pleural effusion were 26(18.1%) and 57(39.6%), respectively. The detection rates of inflammatory effusion were 103(71.5%) and 87(60.4%), respectively. The detection rates in suspicious malignancy were 15(10.4%) and 0(0.0%), respectively, and the differences were statistically significant. Conclusion The cell wax block + immunohistochemical method is superior to the traditional smear method in the diagnosis of exudative pleural effusion, especially in the suspicious malignant effusion. It can not only determine the nature of effusion but also determine the tissue. Source, but the traditional smear method is simple, the price is favorable, although there is a certain rate of missed diagnosis, but the rate of misdiagnosis is low and the laboratory requirements are relatively low, it is more suitable for the initial screening of clinical patients. The combined examination of the two methods can not only improve the detection rate but also reduce unnecessary inspections, and has high value in clinical applications.
Objective To analyze the comparison between traditional smear and cell wax block + immunohistochemistry in the diagnosis of exudative pleural effusion, and to explore its application value in clinical diagnosis. Methods A total of 144 samples of exudative pleural effusion were obtained from the First Affiliated Hospital of Baotou Medical College. The traditional smear and cell wax block + immunohistochemistry were used to observe the morphology and staining of the exudative thoracic cavity. The effusion was diagnosed, and the statistical difference between the two methods in pleural effusion was statistically analyzed, and its value in clinical application was inferred. Results In the diagnosis of exudative pleural effusion, the detection rates of traditional smear and cell wax block + immunohistochemistry in malignant pleural effusion were 26(18.1%) and 57(39.6%), respectively. The detection rates of inflammatory effusion were 103(71.5%) and 87(60.4%), respectively. The detection rates in suspicious malignancy were 15(10.4%) and 0(0.0%), respectively, and the differences were statistically significant. Conclusion The cell wax block + immunohistochemical method is superior to the traditional smear method in the diagnosis of exudative pleural effusion, especially in the suspicious malignant effusion. It can not only determine the nature of effusion but also determine the tissue. Source, but the traditional smear method is simple, the price is favorable, although there is a certain rate of missed diagnosis, but the rate of misdiagnosis is low and the laboratory requirements are relatively low, it is more suitable for the initial screening of clinical patients. The combined examination of the two methods can not only improve the detection rate but also reduce unnecessary inspections, and has high value in clinical applications.
引文
[1]中国恶性胸腔积液诊断与治疗专家共识组.恶性胸腔积液诊断与治疗专家共识[S].中化内科杂志,2014,53(3):252-256.
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[5]Morisson P,Neves DD.Evaluation of adenosine deaminase in the diagnosis of pleural tuberculosis:a Brazilian metaanalysis[J].J Bras Pneumol,2008,34(4):217-224.
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[7]Huang CC.Cytomorphological features of metastatic squamouscell carcinoma in serous effusions[J].Cytopathology,2014,25(2):112.
[8]Villena G,Cases V,Fernández V,et al.Recommendations of diagnosis and treatment of pleural effusion.Update[J].Arch Bronconeumol,2014,50(6):235-249.
[2]Psallidas I,Kalomenidis I,Porcel JM,et al.Malignant pleural effusion:from bench to bedside[J].Eur Respir Rev,2016,25(140):189-198.
[3]van de Molengraft FJ,van‘t Hof MA,Herman CJ,et al.Quantitative light microscopy of atypical mesothelial cells and malignant cells in ascitic fluid[J].Anal Quant Cytol,1982,4(3):217-220.
[4]McGrath EE,Anderson PB.Diagnosis of pleural effusion:a systematic approach[J].Am J Crit Care,2011,20(2):119-127.
[5]Morisson P,Neves DD.Evaluation of adenosine deaminase in the diagnosis of pleural tuberculosis:a Brazilian metaanalysis[J].J Bras Pneumol,2008,34(4):217-224.
[6]张爱华,赵玮,王凌芬,等.浆膜积液恶性肿瘤细胞学诊断及鉴别诊断[J].河北医药,2001,32(10):751.
[7]Huang CC.Cytomorphological features of metastatic squamouscell carcinoma in serous effusions[J].Cytopathology,2014,25(2):112.
[8]Villena G,Cases V,Fernández V,et al.Recommendations of diagnosis and treatment of pleural effusion.Update[J].Arch Bronconeumol,2014,50(6):235-249.