DNA倍体分析对液基细胞学在良恶性胸腹水诊断中的支持价值  

Diagnostic value of DNA ploidy analysis to support liquid based cytology for benign and malignant pleural effusion and ascities

作　　者：杨圆圆 刘恩杰 张云飞[3] 李晟磊[2] YANG Yuanyuan;LIU Enjie;ZHANG Yunfei;LI Shenglei(School of Basic Medical Sciences,Zhengzhou University,Henan Zhengzhou 450001,China;Department of Pathology,the First Affiliated Hospital of Zhengzhou University,Henan Zhengzhou 450052,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Zhengzhou University,Henan Zhengzhou 450052,China)

机构地区：[1]郑州大学基础医学院,河南郑州450001 [2]郑州大学第一附属医院病理科,河南郑州450052 [3]郑州大学第一附属医院胃肠外科,河南郑州450052

出　　处：《现代肿瘤医学》2024年第11期2069-2073,共5页Journal of Modern Oncology

基　　金：国家自然科学基金(编号:82001134)。

摘　　要：目的:探讨液基细胞学、肿瘤标志物和DNA倍体分析单独和联合在良恶性胸腹水诊断中的鉴别价值。方法:收集312例同时做过胸腹水液基细胞学检查、DNA倍体分析和血清肿瘤标志物检测的病例,且所有病例都有组织病理诊断结果,对这些指标及人口统计学特征进行分析;基于液基细胞学、肿瘤标志物、DNA倍体分析单独及其组合的诊断,通过Logistic回归建立组合模型,并通过ROC曲线下面积(AUC)进行比较,以及计算其对应的敏感度(SE)、特异度(SP)、阳性预测值(PPV)和阴性预测值(NPV)。结果:以组织病理诊断结果为金标准,液基细胞学、肿瘤标志物和DNA倍体分析的AUC值分别是0.702、0.512、0.776;模型1(液基细胞学联合肿瘤标志物)AUC值为0.722,SE为49.8%,SP为90.6%,PPV为79.5%,NPV为24.5%;模型2(液基细胞学联合DNA倍体分析)AUC值为0.783,SE为68.7%,SP为83.00%,PPV为95.2%,NPV为35.2%;模型3(模型2联合肿瘤标志物)AUC值0.776,SE为58.7%,SP为88.7%,PPV为85.3%,NPV为29.8%;模型2表现出对良恶性胸腹水最高的诊断效率,液基细胞学和DNA倍体分析组合的AUC值高于液基细胞学(P<0.0001)和DNA倍体分析(P=0.3998)。结论:DNA倍体分析的诊断价值高于液基细胞学和传统肿瘤标志物;DNA倍体分析对液基细胞学在良恶性胸腹水的诊断中具有支持价值,提供了一种鉴别良恶性胸腹水的可靠模式。Objective:To explore the differential value of liquid-based cytology,tumor marker and DNA ploidy analysis alone and in combination in the diagnosis of benign and malignant pleural effusion and ascities.Methods:312 cases with pleural effusion and ascities fluid-based cytology examination,DNA ploidy analysis and serum tumor marker detection,and the histopathological diagnosis results of all cases were collected,and analyzed these indicators and demographic characteristics.Based on fluid-based cytology,tumor markers,DNA ploidy analysis alone and its combination,the combined model was established by Logistic regression,compared by the area under the ROC curve(AUC),sensitivity(SE),specificity(SP),positive predictive value(PPV)and negative predictive value(NPV).Results:With the histopathological diagnostic results as the gold standard,the AUC of liquid-based cytology,tumor markers,and DNA ploidy analysis were 0.702,0.512,and 0.776,respectively.The AUC of Model 1(fluid-based cytology combined with tumor markers)was 0.722,the SE was 49.8%,the SP was 90.6%,the PPV was 79.5%,the NPV was 24.5%.For Model 2(fluid-based cytology combined with DNA ploidy analysis),the AUC was 0.783,the SE was 68.7%,the SP was 83.00%,the PPV was 95.2%,the NPV was 35.2%.For Model 3(Model 2 combined with tumor markers),the AUC was 0.776,the SE was 58.7%,the SP was 88.7%,the PPV was 85.3%,the NPV was 29.8%.Model 2 showed the highest diagnostic efficiency for benign and malignant pleural effusion and ascities.The AUC of the combination of liquid-based cytology and DNA ploidy analysis was higher than that of liquid-based cytology(P<0.0001)and DNA ploidy analysis(P=0.3998).Conclusion:The diagnostic value of DNA ploidy analysis is higher than that of liquid-based cytology and traditional tumor markers.DNA ploidy analysis is of support value for liquid-based cytology in the diagnosis of benign and malignant pleural effusion and ascities,and provides a reliable model for distinguishing benign and malignant pleural effusion and ascities.

关 键 词：DNA倍体分析 液基细胞学 肿瘤标志物 胸腹水 ROC曲线 

分 类 号：R730.58[医药卫生—肿瘤]