免疫细胞化学标记在积液细胞学鉴别诊断中的应用

目的探讨免疫细胞化学特异性标记非肿瘤性增生的间皮细胞、转移性腺癌及恶性间皮瘤细胞在积液细胞学鉴别诊断中的意义。方法浆膜腔积液标本170例,苏木素-伊红(HE)染色,镜检细胞学形态,免疫细胞化学标记一系列单克隆抗体:癌胚抗原(CEA)、上皮细胞膜抗原(EMA)、细胞角蛋白(CK)、上皮相关抗原(MOC-31)、上皮细胞钙粘蛋白E、波形蛋白(VIM)和结蛋白。酶染色采用生物素化酶二步法。采用双盲法阅读免疫细胞化学染色结果。结果上述几种抗体在反应性增生的间皮细胞、癌和恶性间皮瘤3组标本中表达差异有统计学意义(P<0.01)。其中癌症组的CEA、EMA、MOC-31、钙粘蛋白E和CK阳性表达率分别为88%、97%、89%、92%和94%,而VIM和结蛋白呈现低表达,阳性表达率分别为6%和11%。良性间皮细胞标本组中,VIM和结蛋白阳性表达率分别为84%和91%,而CEA、EMA、MOC-31、钙粘蛋白E显示低表达,阳性表达率分别为13%、16%、9%和6%。恶性间皮瘤标本组中,CK、VIM、结蛋白呈现强阳性表达,阳性率为100%,而CEA、EMA、MOC-31、钙粘蛋白E表达呈阴性。结论选择一组特异性免疫细胞化学标记,可帮助传统的细胞形态学检查,对良、恶性浆膜腔积液的鉴别诊断起重要作用。

The application of immunocytochemistry markers in cytological differential diagnosis of effusion smear

Objective To evaluate the significance of immunocytochemistry markers of reactive methothelium(RM),adenocarcioma(AC) and malignant mesothelioma(MM) in cytological differential diagnosis of effusion smear. Methods A total of 170 specimens of effusion were first evaluated by the traditional microscopy with hematoxylin-eosin,and then stained by a panel of immunocytochemistry markers including carcinoembryonic antigen(CEA),epithelial membrane antigen(EMA),epithelial-related antigen(MOC-31),E-cadherin,cytokeratin(CK),vimentin(VIM) and desmin.The immunoreaction results were evaluated independently by two senior cytopathologists and were analysed by double-blind method. Results Statistical significance was found in the expression differentiation among the three groups mentioned above,comparing the groups of RM,AC and MM(P<0.01).CEA,EMA,MOC-31,E-cadherin and CK in the AC group showed high positive rates(88%,97%,89%,92% and 94% respectively),whereas the positive rates of VIM and desmin were low(6% and 11% respectively);The results of VIM and desmin,in group showed high positivity with 84% and 91%,respectively,whereas the results of CEA,EMA,MOC-31 and E-cadherin showed low positivity with 13%,16%,9% and 6%,respectively.The VIM,desmin and CK in the MM group showed high positivity all were 100%. Conclusions Immunocytochemistry study using a panel of monoclonal antibodies is helpful in differential diagnosis between malignant and benign lesions in effusion smears.