薄层细胞涂片在术中诊断胰腺癌的应用价值  

The value of thin-layer cytology in intraoperative fine-needle aspiration biopsy of pancreatic cancer

作　　者：张智慧[1] 赵东兵[2] 赵琳琳[1] 潘秦镜[1] 单毅[2] 王成锋[2] 赵平[2] 

机构地区：[1]中国医学科学院肿瘤医院病理科细胞学室,北京100021 [2]中国医学科学院肿瘤医院腹部外科,北京100021

出　　处：《中华肿瘤杂志》2008年第6期476-479,共4页Chinese Journal of Oncology

基　　金：国家“十五”科技攻关计划资助项目（2004BA703811）

摘　　要：目的探讨薄层细胞涂片（TLC）在胰腺癌手术中针吸穿刺细胞学诊断中的应用价值。方法对临床和影像学诊断为胰腺癌并行剖腹探查术的221例患者，进行术中细胞学诊断，其中仅行传统涂片（CS）20例，仅行TLC151例，同时行CS和TLC两种涂片50例，同时行FNA和穿刺冰冻20例。结果271例次中，行CS共70例患者，不满意标本5例（7．1％）；行TLC共201例患者，不满意标本9例（4．5％）。两种涂片方法不满意标本所占比例，差异无统计学意义（P〉0．05）。行CS的70例患者，诊断阳性42例，阳性率为60．0％；行TLC的201例患者，诊断阳性164例，阳性率为81．6％，高于CS组（P〈0．01）。行CS的70例患者中，19例有术后病理诊断，45例有CT、MR、术中探查及细胞学4项结果，均诊断为癌，敏感性为68．9％。行TLC的201例患者中，80例有术后病理诊断，111例有CT、MR、术中探查及细胞学4项结果，均诊断为癌，敏感性为87．7％，高于CS组（P〈0．01）。术中同时行FNA和粗针穿刺的20例患者，FNA和活检冰冻的阳性率均为90．0％，敏感性均为90．0％，两者联合的敏感性为95．0％。9例患者送检细胞学2次，术后病理诊断均为恶性，其中7例第2次送检查到腺癌细胞。结论TLC涂片阳性率和敏感性高，是术中诊断胰腺癌最好的方法之一，若能与冰冻活检联合应用于临床，可望进一步提高诊断的敏感性。Objective The purpose of this study was to explore the value of thin-layer cytology （TLC） in intraoperative fine needle aspiration cytology diagnosis of pancreatic cancer. Methods Results of cytological examination with thin-layer smears were compared with that with conventional smears in intraoperative fine-needle aspiration （FNA） biopsy. Results Totally 271 fine needle aspiration biopsies were performed, among them, 70 were examined with thin-layer smears, showing unsatisfactory smear in 5 cases （7.1%） ; 201 were examined with conventional smears （ CS）, showing unsatisfactory smear in 9 cases （4.5%）. No significant difference in the unsatisfactory smears was observed between those two groups. The positive rate of diagnosis with CS smears was 60.0% （42/70） and that of TLC was 81.6% （164/201）, with a significant difference （P〈0.01）. The sensitivity of CS and TLC was 68.9% and 87.7%, respectively （ P 〈 0.01 ）. The sensitivity of both FNA and frozen section diagnosis in 20 cases was 90.0%, respectively, but that of FNA combined with frozen section diagnosis was 95.0%. 9 cancer cases diagnosed by pathology were initially negative by cytology, but adenocareinoma cells were found in 7 cases of them by the second time cytology examination. Conclusion The positive rate is high in TLC smears, and unsatisfactory rate is low. TLC smears are one of the best methods in intraoperative confirmation of pancreatic cancer. The use of FNA smears combined with frozen section biopsy can further improve the sensitivity of diagnosis.

关 键 词：针吸穿刺细胞学 胰腺肿瘤 薄层细胞涂片 

分 类 号：R686[医药卫生—骨科学]