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目的探讨液基细胞学结合DNA定量分析鉴别诊断浆膜腔积液良恶性细胞的应用价值。方法收集297例(包括179例恶性、118例炎性,均经临床或病理诊断证实)胸腹水标本,每例标本采用液基细胞技术制成3张薄层细胞片,2张细胞片做H-E染色,用于细胞学检查;另1张经Feulgen-Thionin染色,应用SPICM-DNA全自动细胞图象分析系统方法进行细胞核DNA定量测定。结果液基细胞学方法对恶性和炎性胸腹水的诊断阳性率分别为82.7%(148/179)、83.9%(99/118),AICM的诊断阳性率分别为97.2%(174/179)、100%(118/118)。在癌性胸腹水检测中,SPICM-DNA全自动细胞图象分析系统可检出数量不等的DI>2.5异倍体细胞,而炎性胸腹水不能检出该类细胞。两种方法结合对恶性胸腹水的阳性诊断率为98.3%(177/179)。结论液基细胞学结合DNA定量分析用于胸腹水良性与恶性细胞的鉴别诊断较细胞学方法敏感,不但能避免漏诊,还可对恶性细胞分型诊断。
Objective To investigate the value of liquid-based cytology combined with DNA quantitative analysis in the differential diagnosis of benign and malignant serous effusions. Methods Thoracic and ascites samples from 297 patients (including 179 malignant and 118 inflammatory patients were confirmed by clinical or pathological diagnosis) were collected. Three specimens of thin-section cells were made using liquid-based cell technique in each specimen. Two of them were used for HE Staining for cytological examination; the other one by Feulgen-Thionin staining using SPICM-DNA automated cell image analysis system for nuclear DNA quantitative determination. Results The positive rates of liquid-based cytology in the diagnosis of malignant and pleural effusion were 82.7% (148/179) and 83.9% (99/118), respectively. The positive rates of AICM were 97.2% (174/179) 100% (118/118). In the detection of cancerous pleural effusion and ascites, the SPICM-DNA automated cell image analysis system can detect DI> 2.5 aneuploid cells in varying numbers, whereas the inflammatory pleural and ascitic fluids can not detect such cells. The positive rate of the combined diagnosis of malignant pleural and hydrothorax was 98.3% (177/179). Conclusion liquid-based cytology combined with DNA quantitative analysis of benign and malignant pleural effusion as the differential diagnosis of cytological methods sensitive, not only to avoid missed diagnosis, but also for the diagnosis of malignant cells.