全自动DNA定量技术对胰腺恶性肿瘤的诊断价值

摘要

Objective To estimate the diagnostic value of cytology, DNA-ICM(DNA-image cytometry),cytology combined with DNA-ICM for pancreatic malignancy,and to explore the cut-off value for DNA-ICM. Methods Patients with suspicious pancreatic malignancy were retrospectively identified. In total,145 EUS-FNA specimens acquired from 140 separate patients were examined by cytology and DNA-ICM. Diagnostic values among cytology, DNA-ICM and the combination of the techniques in detecting pancreatic malignancy were compared. Results Compared with cytology, DNA-ICM had a lower sensitivity (63.0% VS 82.4%)and accuracy(69.7% VS 85.5%). After combining the techniques, the diagnostic value for pancreatic malignancy significantly improved compared with that by cytology(0.941 VS 0.912, P=0.007 0)or DNA-ICM only(0.941 VS 0.815, P<0.000 1). By using the Youden index, the cut-off value for DNA-ICM to detect pancreatic malignancy was one cell with DI(DNA index)≥2.5. Notably,with this standard, the sensitivity and accuracy of DNA-ICM significantly increased to 72.3% and 77.2%, and those of the combined techniques increased to 91.6% and 93.1%, respectively. Conclusion Automated DNA-ICM is an objective and effective method for pancreatic malignancy. Although DNA-ICM has a lower diagnostic value than that of conventional cytology, an improved value was obtained after combining the techniques.%目的 对比细胞病理学、全自动DNA定量分析技术及两法联合对胰腺恶性肿瘤内镜超声引导下细针抽吸术(EUS-FNA)标本的诊断价值,并探索DNA定量分析诊断胰腺恶性肿瘤的诊断截断点.方法 回顾性收集140例可疑胰腺恶性肿瘤患者的145份EUS-FNA标本的细胞病理学及全自动DNA定量分析结果,以术后病理结合临床随访结果为金标准,统计两种方法及两法联合对胰腺恶性肿瘤的诊断符合率.结果 全自动DNA定量分析技术诊断胰腺恶性肿瘤的灵敏度(63.0%比82.4%)及准确率(69.7%比85.5%)低于细胞病理学,两法联合诊断胰腺恶性肿瘤的曲线下面积明显高于单一细胞病理学(0.941比0.912,P=0.0070)或DNA定量分析(0.941比0.815,P<0.0001),差异具有统计学意义.利用约登指数,当全自动DNA定量分析出至少1个细胞DNA指数≥2.5时即可提示为恶性肿瘤.利用该截断值诊断时,全自动DNA定量分析的灵敏度和准确率可提高至72.3%和77.2%,两法联合灵敏度和准确率可分别提高至91.6%和93.1%.结论 全自动DNA定量分析EUS-FNA标本是一种省时、有效和客观的诊断恶性肿瘤技术.尽管其诊断价值低于传统的细胞病理学,但是两种方法联合可明显提高诊断符合率.