Kundu Reetu, Handa Uma, Mohan Harsh
Government Medical College & Hospital, Sector 32-A, Chandigarh 160030, India.
Diagn Cytopathol. 2012 Oct;40(10):887-92. doi: 10.1002/dc.21673. Epub 2011 Apr 11.
Body cavity fluid examination sometimes presents a diagnostic challenge in cytology practice. This study was undertaken to evaluate efficacy of cytomorphology, epithelial membrane antigen immunocytochemistry (EMA-ICC) and DNA flow cytometry (FCM) in detection of malignant cells in effusions. One hundred effusions (55 pleural, 44 ascitic, and 1 pericardial fluid) were studied by cytology, EMA, and FCM. There were 29 malignant and 71 benign cases. On cytology, 28 of 29 malignant cases were diagnosed. With no false positives, the sensitivity and specificity was 96.55% and 100% respectively. FCM detected aneuploidy in 85.71% of cytologically malignant and 4.17% of cytologically benign effusions. EMA was positive in 75% of cytologically malignant and 4.17% of cytologically benign cases. EMA had lower sensitivity than cytology; 75.86% versus 96.55%. Sensitivity and specificity of FCM was 86.21%, and 97.18% respectively. FCM had lower sensitivity than cytology; 86.21% versus 96.55%. Sensitivity increased to 100% (P < 0.05) when the combinations of cytology plus EMA or cytology plus ploidy were applied compared to cytology alone (96.55%). Also, the combination of cytology plus EMA had higher sensitivity than EMA alone (100% versus 75.86%, P < 0.05) and combined cytology plus ploidy had higher sensitivity than ploidy alone (100% versus 86.21%, P < 0.05). The study demonstrates the usefulness of EMA-ICC and DNA FCM as adjuncts to cytology to diagnose malignancy in effusions. FCM in combination with ICC can be further developed to reduce number of false-negative cases on cytology and add objectivity to cytologically doubtful or equivocal cases.
体腔液检查在细胞学实践中有时会带来诊断挑战。本研究旨在评估细胞形态学、上皮膜抗原免疫细胞化学（EMA-ICC）和DNA流式细胞术（FCM）在检测积液中恶性细胞方面的效果。通过细胞学、EMA和FCM对100例积液（55例胸腔积液、44例腹水和1例心包积液）进行了研究。其中有29例恶性病例和71例良性病例。在细胞学检查中，29例恶性病例中有28例被诊断出来。无假阳性结果，敏感性和特异性分别为96.55%和100%。FCM在85.71%的细胞学恶性积液和4.17%的细胞学良性积液中检测到非整倍体。EMA在75%的细胞学恶性病例和4.17%的细胞学良性病例中呈阳性。EMA的敏感性低于细胞学检查；分别为75.86%和96.55%。FCM的敏感性和特异性分别为86.21%和97.18%。FCM的敏感性低于细胞学检查；分别为86.21%和96.55%。与单独的细胞学检查（96.55%）相比，当应用细胞学加EMA或细胞学加倍体组合时，敏感性提高到100%（P<0.05）。此外，细胞学加EMA的组合比单独的EMA具有更高的敏感性（100%对75.86%，P<0.05），细胞学加倍体组合比单独的倍体具有更高的敏感性（100%对86.21%，P<0.05）。该研究证明了EMA-ICC和DNA FCM作为细胞学辅助手段在诊断积液恶性肿瘤中的有用性。FCM与ICC联合应用可进一步发展，以减少细胞学检查中的假阴性病例数量，并为细胞学上可疑或不明确的病例增加客观性。
