恶性胸腔积液去血细胞块临床应用价值研究

Clinical diagnostic value of cell block post RBC removal in malignant pleural effusion

关键词:  胸腔积液  胸膜疾病  恶性胸腔积液  细胞块  胸膜病理

Key words:  pleural effusion  pleural diseases  malignant pleural effusion  cell block  pleural pathology

摘要:

目的　通过与胸膜配对比较观察去血细胞块的临床应用价值。方法　收集2015年1月至2016年6月在大连市中心医院呼吸科就诊的可疑恶性胸腔积液患者36例，血性积液占47.22%。使用50%酒精作为去血剂制成细胞块，随后行内科胸腔镜获得胸膜病理结果。通过与胸膜病理对比观察去血细胞块的检出率、制片质量、免疫组化染色的差异。结果　血性、非血性积液的细胞块及胸膜病理的检出率分别为64.71%、78.95%、88.89%，血性与非血性细胞块比较及两组与胸膜病理比较差异均无统计学意义。细胞块联合胸膜病理检出率在非血性、淡血色及深血色胸腔积液中可达94.74%、100%及100%。非血性、淡血色与深血色积液细胞块切片中不能用于诊断切片的检出率分别为10.53%（9/51），9.52%（2/21），20.00%（6/30），两两比较差异均无统计学意义。红细胞背景干扰诊断的切片在上述3组中检出率分别为0、0、7.84%（4/30），深血色积液组与其他两组的差异有统计学意义。去血细胞块与配对胸膜的免疫组化染色结果对比差异无统计学意义。结论　细胞块病理作为一种创伤更小的检查方法，能够成为胸膜病理的补充。

Abstract:

Objective To investigate the diagnostic value of cell block through comparison with paired pleural biopsy. Methods Pleural effusions were collected from patients with suspected malignancy in Dalian Municipal Central Hospital from 2015 Jan to 2016 June. Cell blocks were prepared and red blood cells (RBCs) were removed using 50% ethyl alcohol if the effusion was bloody. Thoracoscopy was then performed to obtain pleural biopsy. The detection rate and the quality of pathological slices and immunohistochemical stains were compared between cell block and pleural biopsy. Results Malignant pleural effusions were finally collected from 36 patients, including 47.22% bloody effusion and 27.78% dark bloody effusion. The detection rates were 64.71%, 78.95% and 88.89%, respectively in bloody cell block post RBC removal, non-bloody cell block and pleural biopsy. There weren't statistical differences among groups. The detective rates reached 94.74%, 100% and 100%, respectively in the cell block post RBC removal, non-bloody cell block and pleural biopsy if the cell block came with pleural biopsy. The slices that couldn' t be use for diagnosis were 10.53%，9.52% and 20.00%, respectively in non-bloody, light bloody and dark bloody group. There weren't statistical differences among groups. The slices that couldn' t be use for diagnosis due to too much erythrocyte in background were 0, 0 and 7.84%, respectively in the above-mentioned group. There were statistical significant in dark bloody group compared with the other two groups. Thus, too many RBCs in background would disturb diagnosis. The immunohistochemical stains were consistent in the cell block post RBC removal compared to the paired pleural biopsy. Conclusion Pathological diagnosis using cell block has smaller wound and is a supplemental to pleural biopsy.