临床-影像-病理学评估在恶性胸膜间皮瘤诊断中的价值  

The Diagnostic Values of Clinical-Radiological-Pathological Evaluation for Malignant Pleural Mesothelioma

作　　者：侯刚[1] 于涓瀚[2] 王秋月[1] 康健[1] 

机构地区：[1]中国医科大学附属一院呼吸疾病研究所,辽宁省沈阳市110001 [2]中国医科大学病理教研室

出　　处：《中国全科医学》2011年第28期3243-3245,共3页Chinese General Practice

摘　　要：目的比较胸膜活检前临床分析所得出的初步诊断与病理诊断的符合性,探讨临床-影像-病理学评估在恶性胸膜间皮瘤诊断中的价值。方法收集我院2006年9月—2010年12月收治的经病理学证实的恶性胸膜间皮瘤患者13例,胸膜转移性腺癌患者13例,比较胸膜活检前的临床诊断与病理诊断的符合率,评估临床诊断的准确性,同时评价病理诊断中波形蛋白(Vimentin,VIM)、间皮瘤抗体(Mesothelial Cell,MC)、神经特异性钙结合蛋白(Cal-retinin,CR)、癌胚抗原(CEA)、甲状腺转录因子-1(Thyroid transcription factor-1,TTF-1)5项指标在恶性间皮瘤和胸膜转移性肺腺癌鉴别中的应用价值。结果 13例恶性胸膜间皮瘤中,临床诊断与病理诊断的符合率为53.9%,13例胸膜转移性腺癌诊断符合率为61.5%。VIM、MC、CR、TTF-1、CEA等5项指标在恶性胸膜间皮瘤组和转移性腺癌组的表达差异有统计学意义(P<0.05)。VIM在恶性间皮瘤诊断中的敏感性最高,为92.3%;CR特异性最高,为84.6%。TTF-1在转移性腺癌诊断中的敏感性较高,为69.2%;CEA特异性较高,为92.3%。结论恶性胸膜间皮瘤的临床-影像学诊断准确率低,恶性胸膜间皮瘤的诊断应采取临床-影像-病理学评估,尤其要重视VIM、MC、CR、TTF-1、CEA指标在病理诊断中的作用。Objective To compare results from preliminary diagnosis drawn from clinical analysis before pleural biopsy and results from pathological diagnosis and to explore the values of clinical-radiological-pathological evaluation in the diagnosis of malignant pleural mesothelioma. Methods Data of 13 malignant pleural mesothelioma cases and 13 metastatic pleural adenocarcinoma cases from our hospital between Sep.2006 and Dec.2010 were collected with the diagnostic conclusions from pre-biopsy analysis and from pathological diagnosis compared in order to evaluate the diagnostic values of clinical analysis.At the same time,application values of pathological indices including vimentin（VIM）,mesothelial cell（MC）,Calretinin（CR）,CEA,and thyroid transcription factor-1（TTF-1） in the differential diagnosis of malignant pleural mesothelioma and metastatic adenoma were investigated. Results Concordance rates between preliminary clinical diagnosis and pathological diagnosis were 53.9% and 61.5% for malignant pleural mesothelioma and pleural metastatic adenocarcinoma respectively.Expression of immunochemistry indices（VIM,MC,CR,CEA,TTF-1）were significantly different between malignant pleural mesothelioma and metastatic adenocarcinoma（P0.05）.For the diagnosis of malignant pleural mesothelioma,VIM displayed the highest sensitivity of 92.3%,while CR had the highest specificity of 84.6%.For the diagnosis of pleural metastatic adenocarcinoma,TTF-1 had the highest sensitivity of 69.2% while CEA had the highest specificity of 92.3%. Conclusion The total accuracy of malignant pleural mesothelioma diagnosis by clinical-radiological methods is relatively low so that more stress should be laid on the comprehensive clinical-radiological-pathological analysis,especially the immunohistochemistry staining of the pathological samples.

关 键 词：胸膜恶性间皮瘤 影像学 免疫组织化学 病理学 

分 类 号：R730.262.7[医药卫生—肿瘤]