She Wenyu, Yang Jun, Wang Chengshuo, Zhang Luo
1 Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
2 Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China.
Am J Rhinol Allergy. 2018 May;32(3):181-187. doi: 10.1177/1945892418768581. Epub 2018 Apr 17.
Back ground: Nasal cytology has generally been employed as a useful diagnostic tool in the differentiation of rhinopathies. Objective The aim of this study was to assess the extent and diagnostic value of inflammation of nasal and paranasal sinus mucosa in chronic rhinosinusitis patients by employing a combination of nasal brushings and a liquid-based cytological technique. Methods Forty-eight patients with chronic sinusitis and 20 control subjects without any sign of sinusitis undergoing endoscopic surgery, although not all underwent endoscopic sinus surgery, were recruited to the study. Nasal cytology samples were collected from all subjects using nasal brush and processed a liquid-based cytological technique for evaluation of total and differential inflammatory cell counts. Biopsies were also taken from the inferior turbinates from its anterior margin in all subjects and from identical lateral maxillary sinus mucosa in patients with chronic sinusitis during surgery and routinely processed for staining and evaluation of inflammatory cells. Results Total and individual inflammatory cell counts in nasal brushings were significantly correlated with the respective inflammatory cell counts in biopsies obtained from the inferior turbinate (eosinophils: r = .519 and P = .016; neutrophils: r = .540 and P = .012; lymphocytes: r = .540 and P = .011) but not in biopsies obtained from the maxillary sinus. No correlation was observed between the inflammatory cells in biopsies from the inferior turbinate and biopsies from the maxillary sinus. The liquid-based cytological technique showed higher sensitivity (94.1%), specificity (76.9%), and positive predictive value (84.2%) for inflammation in the inferior turbinates than for inflammation in the maxillary sinus (sensitivity = 63.4% and positive predictive value = 63.4%). Conclusion Nasal cytology evaluated by use of nasal brushings processed by a liquid-based cytological technique is likely to have higher diagnostic value for the inflammatory response in noninfectious rhinitis than in chronic rhinosinusitis.
鼻细胞学检查通常被用作鉴别鼻病的一种有用的诊断工具。目的本研究旨在通过联合使用鼻刷检和液基细胞学技术，评估慢性鼻-鼻窦炎患者鼻及鼻窦黏膜炎症的程度和诊断价值。方法招募48例慢性鼻窦炎患者和20例无任何鼻窦炎体征的对照受试者接受内镜手术，尽管并非所有患者都接受了鼻内镜鼻窦手术。使用鼻刷从所有受试者中采集鼻细胞学样本，并采用液基细胞学技术处理，以评估炎症细胞总数和分类计数。在手术过程中，还从所有受试者下鼻甲前缘以及慢性鼻窦炎患者相同的上颌窦外侧黏膜处获取活检组织，常规进行染色并评估炎症细胞。结果鼻刷检中的炎症细胞总数和各类炎症细胞计数与从下鼻甲获取的活检组织中的相应炎症细胞计数显著相关（嗜酸性粒细胞：r = 0.519，P = 0.016；中性粒细胞：r = 0.540，P = 0.012；淋巴细胞：r = 0.540，P = 0.011），但与从上颌窦获取的活检组织中的炎症细胞计数无关。在下鼻甲活检组织和上颌窦活检组织中的炎症细胞之间未观察到相关性。液基细胞学技术对下鼻甲炎症的敏感性（94.1%）、特异性（76.9%）和阳性预测值（84.2%）高于上颌窦炎症（敏感性 = 63.4%，阳性预测值 = 63.4%）。结论通过液基细胞学技术处理鼻刷检样本进行的鼻细胞学检查，对于非感染性鼻炎炎症反应的诊断价值可能高于慢性鼻-鼻窦炎。
