August M, Faquin W C, Troulis M, Kaban L B
Massachusetts General Hospital, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Harvard Medical School, Boston, MA, USA.
J Oral Maxillofac Surg. 2000 Sep;58(9):935-40; discussion 940-1. doi: 10.1053/joms.2000.8731.
In this study, the efficacy of fine-needle aspiration biopsy (FNAB) and cytokeratin 10 immunocytochemical staining to differentiate odontogenic keratocysts (OKC) from dentigerous and other nonkeratinizing cysts was evaluated.
This was a prospective study of 18 FNABs of odontogenic cystic lesions performed at the Massachusetts General Hospital between 1995 and 1998. A consistent and standardized technique was used to obtain the cytologic material. Immunocytochemistry was performed on destained smears by using a monoclonal antibody against cytokeratin 10. Identical immunohistochemical methods were applied to the final surgical specimen, and results were compared.
Cells of 10 of 18 FNABs showed a markedly positive immunoreaction to anti-cytokeratin 10, supporting a diagnosis of OKC. In all 10 cases, the diagnosis was confirmed by histology. Six of 18 cases showed an absence of staining and were interpreted as anti-cytokeratin 10 negative. In the 2 remaining cases, there were occasional squamous cells on the smear with weak anti-cytokeratin 10 uptake. The overall pattern was negative, and these were interpreted as nonkeratinizing cysts. In all 8 of these cases, the diagnosis of OKC was excluded based on the immunocytochemistry, and the final histologic diagnoses were: dentigerous cyst (n = 4) and radicular cyst (n = 4).
The combination of FNAB with immunocytochemical determination of cytokeratin 10 expression by sampled epithelial cells was 100% accurate in distinguishing an OKC from a nonkeratinizing odontogenic cyst in this series. The technique allows for early diagnosis and rational surgical planning.
本研究评估了细针穿刺活检（FNAB）及细胞角蛋白10免疫细胞化学染色在鉴别牙源性角化囊肿（OKC）与含牙囊肿及其他非角化囊肿方面的效能。
这是一项对1995年至1998年间在马萨诸塞州总医院进行的18例牙源性囊性病变的FNAB检查的前瞻性研究。采用一致且标准化的技术获取细胞学材料。通过使用抗细胞角蛋白10单克隆抗体对脱色涂片进行免疫细胞化学检测。对最终手术标本采用相同的免疫组织化学方法，并比较结果。
18例FNAB中的10例细胞对抗细胞角蛋白10呈明显阳性免疫反应，支持OKC的诊断。在所有10例中，组织学检查证实了诊断。18例中有6例显示无染色，被判定为抗细胞角蛋白10阴性。在其余2例中，涂片上偶见鳞状细胞，抗细胞角蛋白10摄取较弱。总体模式为阴性，这些被判定为非角化囊肿。在所有这8例中，基于免疫细胞化学排除了OKC的诊断，最终组织学诊断为：含牙囊肿（n = 4）和根端囊肿（n = 4）。
在本系列研究中，FNAB联合对取样上皮细胞进行细胞角蛋白10表达的免疫细胞化学测定，在区分OKC与非角化牙源性囊肿方面的准确率为100%。该技术有助于早期诊断和合理的手术规划。
