基于细胞形态学定量参数的良恶性胸/腹水鉴别诊断模型  

A differential diagnostic model based on the morphological parameters of exfoliated cells for differentiating malignant pleural and peritoneal effusions from the benigns

作　　者：袁帅[1] 张焜和[2] 肖波[2] 陈江[2] 祝金泉 朱萱[2] 吕农华[2] 

机构地区：[1]广东省南方医科大学附属小榄医院消化科,广东省中山市528415 [2]南昌大学第一附属医院江西省消化疾病研究重点实验室,江西省南昌市330006

出　　处：《世界华人消化杂志》2009年第3期279-283,共5页World Chinese Journal of Digestology

基　　金：江西省主要学科学术与技术带头人计划资助项目;No.030002~~

摘　　要：目的:探讨以脱落细胞形态学定量参数及其变异系数建立数学诊断模型对良恶性胸/腹水的鉴别诊断价值.方法:应用病理显微图像分析系统采集61例良恶性胸/腹水脱落细胞涂片的细胞面积、周长、等效直径、长径、短径、长短径比、形状因子、圆形度、异形指数等9项形态学参数,计算各参数的变异系数.以各参数为自变量,以细胞学诊断结果为因变量,采用逐步判别法分别建立基于不同类型参数的诊断模型,并评价各模型对恶性胸/腹水的诊断价值.结果:等效直径和长径2项参数进入基于细胞形态学参数的诊断模型;除周长和圆形度两项参数的变异系数外其余7项参数的变异系数进入基于各参数变异系数的诊断模型;面积、短径和短径变异系数3项参数进入基于全部参数的诊断模型.上述3个诊断模型诊断恶性积液的敏感度分别为72.7%、90.9%和97.0%,特异度分别为100.0%、92.9%和92.9%,准确度分别为85.2%、91.8%和95.1%.结论:以细胞学形态学参数及其变异系数可建立起简便的数学模型,对胸/腹水良恶性质的鉴别诊断具有良好的价值.AIM： To establish a mathematical model based on the morphological parameters of exfoliated cells in pleural and peritoneal effusions and to evaluate their diagnostic values in differentiating malignant from the benign pleural and peritoneal effusions. METHODS： Nine morphological cellular parameters （area, perimeter, equivalent diameter, maxaxis, min-axis, max-axis/min-axis ratio, form factor, cycle degree, atypical index） were measured using a pathological image analysis system on cell smears from 61 patients with benign or malignant pleural or peritoneal effusions, and the coefficients of variation （CV） of above parameters were calculated. Discriminate functions, diagnostic models, were established with different groups of parameters by stepwise discriminatory analysis, in which the cytological result of each specimen was taken as the dependent variable and the morphological parameters as independent variables, and their diagnostic performances for malignant effusions were calculated. RESULTS： Two parameters, equivalent diameter and max-axis, entered the model based on cellular morphological parameters. Seven CVs of all parameters except for perimeter and cycle degree entered the model based on the CVs. Three parameters, area, min-axis and CV of min-axis, entered the model based on all those parameters. The sensitivities of above three models for diagnosing malignant effusions were 72.7%, 90.9% and 97.0%, respectively; the specificities were 100.0%, 92.9% and 92.9%, respectively, and the accuracies were 85.2%, 91.8% and 95.1%, respectively. CONCLUSION： Simple models could be established based on the cellular morphological parameters and their coefficients of variation, and they are valuable in differentiating malignant from benign pleural and peritoneal effusions.

关 键 词：胸水 腹水 肿瘤转移 鉴别诊断 数学模型 

分 类 号：R446.8[医药卫生—诊断学] R730.4[医药卫生—临床医学]