Köksal Deniz, Demırağ Funda, Bayız Hülya, Koyuncu Adem, Mutluay Neslihan, Berktaş Bahadır, Berkoğlu Mine
Department of Chest Diseases, Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, ANKARA, TURKEY.
Turk Patoloji Derg. 2013;29(3):165-70. doi: 10.5146/tjpath.2013.01184.
Thoracentesis is the first investigation to be performed in a patient with lung cancer and pleural effusion. The diagnostic yield of conventional smear studies varies in the first thoracentesis. In this study, we aimed to investigate if the cell block method increases the diagnostic yield in exudative pleural effusions accompanying lung cancer.
Forty patients with lung cancer and exudative pleural effusions were included. Ten mililiters of fresh pleural fluid was obtained by thoracentesis from all patients in the initial evaluation. The pleural fluid sample was divided into two equal parts. One part was subjected to conventional smear and the other to the cell block method. Conventional smears were stained with May-Grünwald-Giemsa and Hematoxylin-Eosin. Cell block sections were stained with Hematoxylin-Eosin and mucicarmine. Conventional smear findings were grouped as "benign cytology" or "malignant cytology". Th e cell block sections were evaluated for the presence of single tumor cells, acinary or papillary pattern, solid islands and staining with mucicarmine.
There were 20 patients each in the benign and malignant conventional smear group. In the benign group, adding the cell block method to conventional smear provided a diagnosis of malignancy in 4 more patients and the diagnosis of malignant effusion was increased by a ratio of 10% (4/40). In the malignant group, adding the cell block technique provided the subtyping of lung cancer as adenocarcinoma in 7 patients (7/20, 35%).
Our study confirms that the cell block method combined with conventional smear increases the diagnostic yield in exudative pleural effusions accompanying lung cancer.
胸腔穿刺术是肺癌合并胸腔积液患者的首要检查方法。在首次胸腔穿刺术中，传统涂片检查的诊断阳性率各不相同。在本研究中，我们旨在探讨细胞块法是否能提高肺癌伴渗出性胸腔积液的诊断阳性率。
纳入40例肺癌合并渗出性胸腔积液患者。在初始评估时，通过胸腔穿刺术从所有患者中获取10毫升新鲜胸腔积液。胸腔积液样本分为两等份。一份进行传统涂片检查，另一份采用细胞块法。传统涂片用May-Grünwald-Giemsa和苏木精-伊红染色。细胞块切片用苏木精-伊红和黏液卡红染色。传统涂片检查结果分为“良性细胞学”或“恶性细胞学”。对细胞块切片评估单个肿瘤细胞、腺泡或乳头结构、实性岛以及黏液卡红染色情况。
良性和恶性传统涂片组各有20例患者。在良性组中，在传统涂片基础上增加细胞块法使另外4例患者诊断为恶性，恶性胸腔积液的诊断率提高了10%（4/40）。在恶性组中，增加细胞块技术使7例患者（7/20，35%）的肺癌亚型诊断为腺癌。
我们的研究证实，细胞块法与传统涂片相结合可提高肺癌伴渗出性胸腔积液的诊断阳性率。
