Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Lung Cancer. 2013 Jun;80(3):284-8. doi: 10.1016/j.lungcan.2013.02.001. Epub 2013 Feb 28.
It is difficult to differentiate tumor cells in pleural fluid from reactive benign mesothelium. Fluorescence in situ hybridization (FISH) can increase diagnostic accuracy. Two hundred pleural fluid samples were analyzed by using FISH probes for chromosomes 11 and 17. Histological analysis was used to diagnose cancer. Clinical, radiological, and histological data were used to exclude malignancy. Eighty-two pleural effusion samples had positive cytology, 51 were benign, and 67 were atypical, but inconclusive. The 82 positive cases were confirmed to be malignant. Among the 51 negative cytology cases, videothoracoscopy-guided pleural biopsy revealed malignancy in three; aneuploid cells were detected by FISH in all cases. In 43 of the 67 cases with inconclusive cytology, malignancy was confirmed based on histology and fluorescence in situ hybridization. One case of parapneumonic effusion with no evidence of cancer during clinical follow-up had a suspicious cytology and positive fluorescence in situ hybridization result. The remaining 23 cases had no histological, radiological, clinical, or genetic evidence of malignancy. This study demonstrated that cytogenetic analysis of fresh pleural fluid samples using only two FISH probes is a valuable ancillary method for the identification of malignant pleural effusion, particularly in cases in which oncotic cytology is inconclusive.
从反应性良性间皮细胞中鉴别胸腔积液中的肿瘤细胞较为困难。荧光原位杂交（FISH）可提高诊断准确性。使用针对染色体 11 和 17 的 FISH 探针分析了 200 份胸腔积液样本。组织学分析用于诊断癌症。临床、放射学和组织学数据用于排除恶性肿瘤。82 份胸腔积液样本细胞学阳性，51 份为良性，67 份为不典型，但结果不确定。82 例阳性病例被确认为恶性肿瘤。在 51 例细胞学阴性的病例中，胸腔镜引导下胸膜活检显示 3 例为恶性；所有病例均通过 FISH 检测到非整倍体细胞。在 67 例细胞学不确定的病例中，43 例基于组织学和荧光原位杂交证实为恶性。1 例类肺炎性胸腔积液在临床随访中无癌症证据，细胞学可疑且 FISH 结果阳性。其余 23 例无组织学、放射学、临床或遗传学恶性证据。本研究表明，使用仅两种 FISH 探针对新鲜胸腔积液样本进行细胞遗传学分析是鉴定恶性胸腔积液的一种有价值的辅助方法，尤其是在胶细胞学不确定的情况下。
