Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Am Soc Cytopathol. 2023 Nov-Dec;12(6):423-435. doi: 10.1016/j.jasc.2023.09.003. Epub 2023 Sep 9.
This study aims to evaluate diagnostic accuracy of flow cytometry (FCM) in detecting malignant epithelial cells in serous effusions.
Flow cytometric assessment of 96 serous fluids (86 ascitic, 10 pleural) was performed by using epithelial cell adhesion molecule (EpCAM) (in all 96 fluids) and MUC-1 (in a subgroup of 40 fluids) as epithelial markers and CD45 and CD14 as leucocyte markers. The percentage of EpCAM positivity and MUC-1 positivity was calculated in the CD14 and CD45 dual negative population by selective gating. The findings were then correlated with the defined gold standard criteria.
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for EpCAM was found to be 92.06%, 96.96%, 98.31%, 86.48%, and 93.75%, respectively, while that for MUC-1 was 79.16%, 93.75%, 95%, 71.4%, and 85%, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for dual positivity for EpCAM and MUC-1 was found to be 83.3%, 100%, 100%, 80%, and 90% respectively. On combining FCM with cytomorphology the sensitivity, specificity, PPV, NPV, and diagnostic accuracy all increased greatly to 95.3%, 100%, 100%, 91.4%, and 96.8%, respectively.
This study highlights the importance of multicolored flow cytometric analysis in detecting epithelial malignancies in effusions specially in cases belonging to the atypia of undetermined significance and suspicious for malignancy categories and in cases with strong clinical suspicion of malignancy with negative fluid cytology. We recommend the combined use of FCM and cytology for this specific subgroup of patients in routine clinical practice for fast and accurate reporting.
本研究旨在评估流式细胞术（FCM）在检测浆膜液中恶性上皮细胞中的诊断准确性。
使用上皮细胞黏附分子（EpCAM）（所有 96 种液体）和 MUC-1（在 40 种液体的亚组中）作为上皮标志物，CD45 和 CD14 作为白细胞标志物，对 96 种浆膜液（86 种腹水，10 种胸腔积液）进行流式细胞术评估。通过选择性门控计算 EpCAM 阳性和 MUC-1 阳性在 CD14 和 CD45 双阴性群体中的百分比。然后将结果与定义的金标准标准相关联。
EpCAM 的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性分别为 92.06%、96.96%、98.31%、86.48%和 93.75%，而 MUC-1 的敏感性、特异性、PPV、NPV 和诊断准确性分别为 79.16%、93.75%、95%、71.4%和 85%。EpCAM 和 MUC-1 双阳性的敏感性、特异性、PPV、NPV 和诊断准确性分别为 83.3%、100%、100%、80%和 90%。将 FCM 与细胞形态学结合使用后，敏感性、特异性、PPV、NPV 和诊断准确性均大大提高，分别达到 95.3%、100%、100%、91.4%和 96.8%。
本研究强调了多色流式细胞术分析在检测浆膜液中上皮恶性肿瘤中的重要性，特别是在属于意义未确定的不典型和疑似恶性肿瘤类别以及在液体细胞学检查呈阴性但临床强烈怀疑恶性肿瘤的情况下。我们建议在常规临床实践中，对特定的患者亚组联合使用 FCM 和细胞学，以便快速准确地报告。
