背景与目的:胸腹水积良恶性细胞诊断是临床细胞病理上的一个难点,有多种方法用于胸腹积水细胞性质的鉴定,但因复杂而鲜在临床使用.本研究试用DNA全自动图像分析研究恶性胸腹积水细胞中的非整倍体细胞.方法:每例胸腹积水样本50～100 mL经离心去掉上清液,经涂片离心机制成2张玻片.一张玻片用Feulgen染色,用DNA倍体分析仪测定DNA含量:另一张作为对照,经瑞士染色作常规细胞学诊断.结果:463例胸腹积水中,经临床证实有203例为炎性积水,240为痛性积水,20例临床诊断不明.203例炎性积水中,有8例发现1～2个大于5c非整倍体细胞,其余均未见异常倍体细胞;而常规细胞学诊断193例为炎性积水,10例可疑核异质.在240例癌性积水中,DNA倍体分析除7例外,均发现有非整倍体细胞,其中包括6例1～2个大于5c细胞,81例3个或3个以上的大于5c细胞,146例可见异倍体细胞峰;而常规细胞诊断为177例转移性腺癌,16例淋巴瘤、30例间皮细胞瘤,17例发现核异质.20例临床诊断不明病例中DNA倍体分析发现有4例未见倍体异常细胞,16例有非整倍体细胞,其中包括14例1～2个大于5c细胞,2例3个以上大于5c细胞:常规细胞均可见核异质.结论:在大多数癌性胸腹积水中均可见到大于5c异倍体细胞及异倍体细胞峰,DNA倍体分析方法可用于鉴别诊断癌性或炎性胸腹积水.%Background and purpose: It is difficult to identify benign and malignant effusions, even though a few methods were used in clinic. The purpose of this study was to measure a ploid of DNA cells in serous effusions.Methods: 50-100 mL of effusions was collected from each patients and was centrifuged. Two slides were made using a cytospin. One slide was stained with the Wright Solution for conventional cytology, whereas other was stained with Feulgen for DNA quantitative measurement. Results: Total of 463 patients' sample was collected, 20 of them were excluded because the pathology is not clear, and 203 patients were pathologically confirmed as benign and 240 as malignant. In 203 benign effusions, 1 or 2 ＞ 5c aneuploid cells were found in 8 cases by DNA imaging cytometry while 10 cases were suspected to be malignant in conventional cytology. In a total of 240 malignant cases, aneuploid cells were found in 233 cases (including 1 or 2 ＞ 5c aneuploid cells in 6 case, 3 ＞ 5c aneuploid cells in 81 cases and clonal aneuploidy in 146 cases), while there were 177 metastatic adenocarcinoma, 16 malignant lymphoma or leukemia, 30 malignant mesothelioma and 17 that were suspected as malignant, these were all diagnosed via conventional cytology.In 20 undetermined cases, aneuploid cells were detected in 16 cases, including 1-2 ＞ 5c aneuploid cells in 14 cases and more than 3 ＞ 5c aneuploid cells were found in 2 cases. All cases were suspected by cytology to have gone through malignant changes. Conclusion: Aneuploid cells or clonal aneuploidy can be found in the most of malignant effusions, and DNA quantitative measurement could be used to distinguish benign effusion from malignant effusion.
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