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目的研究癌胚抗原(CEA)、上皮膜抗原(EMA)及波形蛋白(vimentin)对胸腹水细胞学鉴别诊断的意义。方法选择我院2010年12月-2012年4月收治的70例胸腹水患者为研究对象,分为良性组33例与恶性组37例,采用免疫细胞化学SP法分别检测癌胚抗原、上皮膜抗原、波形蛋白于细胞内的表达,使用图像分析定量测定脱落细胞的核面积,浆面积及核浆比,细胞周长,平均直径,及圆度、形状因子。结果恶性组患者的腺癌细胞CEA表达均呈阳性,EMA呈部分阴性,vimentin均为阴性;良性组的CEA表达均为阴性,BMA,Vimentin呈部分阳性。恶性组患者腺癌细胞的核面积,浆面积,核浆比,细胞周长,平均直径以及形状因子均高于增生性间皮细胞,但两组细胞圆度无显著差异性(P>0.05)。CEA的灵敏度为60.54%,特异度98.2%,约登指数0.57,准确度79.3%;EMA的灵敏度48.38%,特异度87.45%,约登指数0.31,准确度66.85%;vimentin灵敏度64.1%,特异度87.5%,约登指数0.51,准确度为75.41%。三者联合检测的诊断价值高于单独检测。结论利用免疫细胞化学鉴别良恶性胸腹水具有较高的临床价值,通过将癌胚抗原,上皮膜抗原,波形蛋白三者结合进行定量分析,可以提高胸腹水细胞学诊断的阳性率及准确性。
Objective To study the significance of carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA) and vimentin in differential diagnosis of ascites and pleural effusion cytology. Methods Seventy patients with ascites and pleural effusion admitted to our hospital from December 2010 to April 2012 were selected and divided into 33 cases of benign group and 37 cases of malignant group. Immunocytochemistry SP method was used to detect the expression of carcinoembryonic antigen, epithelial membrane Antigen and vimentin were expressed intracellularly. Image analysis was used to quantitatively determine exfoliated cells’ nuclear area, plasma area and cytoplasm, cell circumference, average diameter, roundness and shape factor. Results The malignant group of patients with adenocarcinoma cells showed positive CEA expression, EMA was partially negative, vimentin were negative; benign group CEA expression were negative, BMA, Vimentin was partially positive. The malignant group of adenocarcinoma cells had higher nuclear area, plasma area, cytoplasm ratio, cell perimeter, mean diameter and shape factor than those of proliferative mesothelial cells, but there was no significant difference between the two groups (P> 0.05) . The sensitivity of CEA was 60.54%, the specificity was 98.2%, the Youden index was 0.57 and the accuracy was 79.3%. The sensitivity and specificity of EMA were 48.38% and 87.45% respectively, and the Youden index was 0.31 and the accuracy was 66.85%. The sensitivity and specificity of vimentin were 64.1% and 98.1% 87.5%, Youden index 0.51, accuracy of 75.41%. The combined diagnostic value of the three is higher than the single test. Conclusions The use of immunocytochemistry to identify benign and malignant ascites and hydrothorax has high clinical value. The combination of carcinoembryonic antigen, epithelial membrane antigen and vimentin can be used to quantitatively analyze the positive rate and accuracy of cytological diagnosis of pleural effusion and ascites.