甲状腺髓样癌的术前诊断:细针穿刺细胞学联合血清降钙素、癌胚抗原及穿刺洗脱液降钙素的应用  

Preoperative diagnosis of medullary thyroid carcinoma: application of FNA combined with serum calcitonin, serum carcinoembryonic antigen and calcitonin in FNA washout fluid

作　　者：沈鑫 朱云[1] 黄波涛[1] 林秀峰[1] 赵菁[1] 沈海燕[1] SHEN Xin;ZHU Yun;HUANG Bo-tao;LIN Xiu-feng;ZHAO Jing;SHEN Hai-yan(Department of Pathology,Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine,Jiangsu Wuxi 214063,China)

机构地区：[1]江苏省原子医学研究所附属江原医院病理科,江苏无锡214063

出　　处：《诊断病理学杂志》2022年第5期417-422,共6页Chinese Journal of Diagnostic Pathology

基　　金：江苏省原子医学研究所青年科研基金(QN202003)。

摘　　要：目的 探讨细针穿刺细胞学结合血清降钙素、癌胚抗原以及穿刺洗脱液降钙素对诊断甲状腺髓样癌(MTC)的价值。方法 回顾性分析41例经组织学病理证实为MTC的细针穿刺标本,总结其细胞学形态特征;收集MTC组和对照组(甲状腺原发性恶性对照组和良性对照组)血清降钙素、癌胚抗原以及穿刺洗脱液降钙素,并探讨它们在鉴别诊断MTC中的临床价值。结果 MTC细针穿刺细胞学主要形态特征有:(1)细胞排列松散、黏附性差;(2)肿瘤细胞具有多形性;(3)浆细胞样细胞;(4)梭形细胞;(5)“胡椒盐”样染色质;(6)背景有淀粉样物。MTC组血清降钙素、血清癌胚抗原、穿刺洗脱液降钙素浓度均明显高于对照组。结论 熟悉掌握MTC细针穿刺细胞学特征有利于提高诊断的准确率,结合血清降钙素、癌胚抗原以及穿刺洗脱液降钙素有助于降低细针穿刺对MTC的误诊、漏诊率。Objective To investigate the value of fine needle aspiration cytology(FNAC) combined with measurement of serum calcitonin(Ct), serum carcinoembryonic antigen(CEA) and calcitonin levels in the fine-needle aspirate washout fluid(FNA-Ct) for the diagnosis of medullary thyroid carcinoma(MTC). Methods We reviewed the FNA records of 41 pathologically diagnosed MTC patients along with 78 control subjects. Morphological features of cytology smears were compared along with measurements of serum Ct, serum CEA and FNA-Ct levels. Results The common morphological presentation of aspirates from MTC patients involved poorly adhesive, dispersed cell patterns with polygonal, plasmacytoid and/or spindle-shaped tumor cells. The presence of amyloid and salt-and-pepper-like chromatin were also observed in MTC cases. Additionally, the levels of serum Ct and CEA along with FNA-Ct were significantly higher in MTC cases compared to controls. Conclusion Familiarity with cytomorphological features of MTC is important for improving diagnostic accuracy in FNA. FNAC together with serum Ct, serum CEA and FNA-Ct measurements can help decrease the rate of MTC misdiagnosis.

关 键 词：甲状腺髓样癌 细针穿刺 降钙素 癌胚抗原 穿刺洗脱液 

分 类 号：R736.1[医药卫生—肿瘤]