端粒酶活性和免疫细胞化学在肿瘤细胞学诊断中的应用  

Application of combined telomerase activity analysis and immunocytochemistry in cytopathologic diagnosis

作　　者：刘岩[1] 徐美林[1] 王菁[1] 吴秉铨[2] 钟镐镐[2] 方伟岗[2] 

机构地区：[1]天津市胸科医院病理科,300051 [2]北京大学医学部病理学系恶性肿瘤发病机制及转化研究教育部重点实验室

出　　处：《中华病理学杂志》2012年第3期181-185,共5页Chinese Journal of Pathology

基　　金：迈新·病理基金课题（M0901）北京肿瘤医院化疔科方健、韩金娣在样本收集工作中提供的帮助

摘　　要：目的探讨端粒酶活性和免疫细胞化学技术在胸腔积液和支气管肺泡灌洗液的离心涂片细胞学诊断中的应用价值。方法选择100例胸腔积液和23例支气管肺泡灌洗液样本，分别进行常规离心涂片细胞学诊断、荧光即时聚合酶链反应端粒酶活性检测和琼脂一石蜡双包埋切片免疫细胞化学染色，并对临床资料进行综合分析。结果123例样本中，端粒酶阳性53例，阴性70例，细胞学阳性即有明确肿瘤细胞的涂片39例，细胞学阴性即未见肿瘤细胞的涂片64例，见有异形细胞的可疑涂片20例，两者结果不符的30例样本结合涂片免疫细胞化学染色和临床随访确定最终诊断。端粒酶检测符合率为87．O％，敏感性为83．0％，特异性为90．0％；细胞学涂片诊断符合率为82．1％，但存在16．3％的诊断灰区，如将两者结合，敏感性和特异性分别提高至97．6％和100．0％。结论端粒酶活性检测和细胞沉淀双包埋切片的免疫细胞化学染色相结合对于体液中异形细胞的良恶性鉴别及恶性细胞组织来源判定具有较高的参考价值，提高了细胞学诊断的敏感性和特异性。Objective To evaluate the application of traditioaal cytomorphology, telomerase activity analysis and immunocytochemistry in cytopathologic diagnosis of pleural effusion and bronchoalveolar lavage samples. Methods A total of 123 agar-paraffin double-embedded pleural effusion and bronchoalveolar lavage fluid samples were enrolled into study. The cytomorphologic features were reviewed and correlated with immunocytochemical findings and telomerase activity. Results Telomerase activity was detected in 53 specimens using the real-time telomeric repeat amplification protocol. Amongst the cases studied, 39 samples （31.7%） contained overtly malignant cells while 20 cases （16.0%） were equivocal by conventional cytology. After verification by immunocytochemistry and clinical follow-up data, the diagnostic accuracy of telomerase activity and cytology was 87.0% and 82. 1%, respectively. The sensitivity （97.6%） and specificity （100. 0% ） of cytology examination, when combined with telomerase activity analysis, were greater than those of cytology examination or telomerasc activity analysis alone. Conclusions Telomerase activity analysis can be used as an adjunctive investigative tool in cytology assessment of pleural effusion and bronchoalveolar lavage samples. The diagnostic accuracy can be further improved with the application of immunocytochemistry on agar-paraffin double-embedded cell block tissues.

关 键 词：胸腔积液 端粒 末端转移酶 免疫组织化学 

分 类 号：R730.4[医药卫生—肿瘤]