CAJ | 학술논문

目的：探讨低温冷藏（4℃）过夜离心法制作浆膜腔积液细胞块的可行性，并评估细胞块免疫组化对提高浆膜腔积液细胞学诊断的价值及其作为基因检测新标本来源的可行性。方法收集2011年至2013年间有组织学确诊的积液152例，均采用直接离心和低温冷藏过夜离心制作细胞块，同时均行传统涂片、细胞块HE染色、免疫组化及检测50例非小细胞肺癌积液细胞块EGFR基因突变情况。结果低温冷藏过夜离心法制作细胞块的成功率（100.0%）显著高于直接离心法（75.0%）（χ2=43.43，P＜0.001）；细胞块免疫组化的诊断准确率（92.1%）明显高于传统涂片（67.1%）和细胞块HE染色（72.4%）（χ2=29.99， P＜0.001）；EMA对癌性积液中的癌细胞诊断具有较高敏感性和特异性，TTF-1、CDX-2、CA125、GCDFP-15、P63和CgA分别对肺腺癌、胃肠腺癌、卵巢癌、乳腺癌、鳞癌和小细胞癌具有较高的敏感性和特异性；非小细胞肺癌积液细胞块EGFR基因突变检出率为44.0%。结论低温冷藏过夜离心法制作细胞块成功率高，操作简单，易于推广；细胞块免疫组化极大地提高了浆膜腔积液细胞学的诊断准确性，同时也可为个体化治疗基因检测提供一种新的标本来源。
목적：탐토저온랭장（4℃）과야리심법제작장막강적액세포괴적가행성，병평고세포괴면역조화대제고장막강적액세포학진단적개치급기작위기인검측신표본래원적가행성。방법수집2011년지2013년간유조직학학진적적액152례，균채용직접리심화저온랭장과야리심제작세포괴，동시균행전통도편、세포괴HE염색、면역조화급검측50례비소세포폐암적액세포괴EGFR기인돌변정황。결과저온랭장과야리심법제작세포괴적성공솔（100.0%）현저고우직접리심법（75.0%）（χ2=43.43，P＜0.001）；세포괴면역조화적진단준학솔（92.1%）명현고우전통도편（67.1%）화세포괴HE염색（72.4%）（χ2=29.99， P＜0.001）；EMA대암성적액중적암세포진단구유교고민감성화특이성，TTF-1、CDX-2、CA125、GCDFP-15、P63화CgA분별대폐선암、위장선암、란소암、유선암、린암화소세포암구유교고적민감성화특이성；비소세포폐암적액세포괴EGFR기인돌변검출솔위44.0%。결론저온랭장과야리심법제작세포괴성공솔고，조작간단，역우추엄；세포괴면역조화겁대지제고료장막강적액세포학적진단준학성，동시야가위개체화치료기인검측제공일충신적표본래원。
ObjectiveTo study the feasibility of refrigeration(4℃) overnight centrifugation method for cell blocks preparation from serous cavity effusion, and to evaluate the diagnosis value of immunohistochemistry staining in cytology and the feasibility of cell block as a new specimen for genetic testing.Methods Cell blocks were prepared by centrifuging with and without refrigeration overnight from the enrolled 152 effusion cytology specimens diagnosed by histopathology. The smears, HE staining and immunohistochemistry staining were performed for all specimens, and EGFR genetic testing was conducted in 50 no-small cell lung cancer specimens. Results After refrigeration overnight, a higher success rate of cell blocks preparation was reached(100.0%vs. 75.0%,χ2=43.43,P<0.001). The accuracy of immunohistochemistry staining(92.1%) was significantly higher than those of both conventional smears(67.1%) and cell blocks HE staining(72.4%)(χ2=29. 99,P<0.001). EMA demonstrated high sensitivity and specificity to cancer cell in malignant effusion; and TTF-1, CDX-2, CA125, GCDFP-15, P63 and CgA showed high sensitivity and specificity to lung adenocarcinoma, gastrointestinal adenocarcinoma, ovarian carcinoma, breast cancer, squamous carcinoma and small cell carcinoma respectively. The EGFR genetic testing ratio was 44.0% in the cell blocks of non-small cell lung cancer.Conclusion Refrigeration overnight centrifugation method show high success rate for cell blocks preparation, and is easy to perform and to popularize. Immunohistochemistry staining for cell blocks demonstrate significantly high diagnosis accuracy in serous cavity effusion, and the effusion cell blocks could be a new specimen source for individualized treatment.