胸腔积液脱落细胞检查在胸膜转移性肺腺癌和恶性间皮瘤所致胸腔积液鉴别诊断中的价值

摘要

[Objective] To evaluate the value of vimentin( VIM) , calretinin(CR) , mesothelial cell(MC) , carcinoembryonic antigen(CKA) and thyroid transcription factor-1 (TTF-1) in the differential diagnosis of pleural metastatic lung adenocarcinoma and malignant pleural mesothelioma. [Methods]Totally 42 patients with pleural metastatic lung adenocarcinoma and 31 patients with malignant pleural mesothelioma confirmed by cytologic diagnosis of pleural effusion or pleural pathological examination in our hospital were collected. Immu-nohistostaining method was used to detect TTF-1, CEA, VIM, MC and CR in exfoliated cell of pleural effusion. The sensitivity, specificity, positive predictive value and negative predictive value of above indicators in pleural metastatic lung adenocarcinoma and malignant mesothelioma were calculated. The value of above indicators in differential diagnosis was evaluated. [ResultsJThere were significant differences in the expression of VIM, CR , MC, TTF-1 and CKA between malignant mesothelioma and pleural metastatic lung adenocarcino-ma( P <0. 05). The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of VIM, CR , MC, TTF-1 and CEA showed significant differences between malignant mesothelioma and pleural metastatic lung adenocarcinoma( P <0. 05). [Conclusion]TIF-1, CEA, VIM, CR and MC of exfoliated cell in pleural effusion have high value in the differential diagnosis of malignant pleural mesothelioma and pleural metastatic lung adenocarcinoma.%[目的]探讨评估波形蛋白(VIM)、神经特异度钙结合蛋白(CR)、间皮细胞(MC);癌胚抗原(CEA)、甲状腺转录因子-1(TTF-1)在胸膜转移性肺腺癌和恶性间皮瘤鉴别诊断中的价值.[方法]经胸腔积液细胞学诊断或胸膜活检病理学证实的恶性胸膜间皮瘤(11例)和胸膜转移性肺腺癌(31例),采用免疫组织化学染色检测胸腔积液脱落细胞中TTF-1、CEA、VIM、MC和CR五项指标,计算其在胸膜转移性肺腺癌和恶性胸膜间皮瘤中的灵敏度、特异度、阳性预测值及阴性预测值,评估五项指标在鉴别诊断中的应用价值.[结果]VIM、CR、MC、TTF-1和CEA在恶性胸膜间皮瘤中的表达与在胸膜转移性肺腺癌中的表达比较有显著性差异(P<0.05);VIM在恶性间皮瘤诊断中的灵敏度为90.9%(10/11),特异度为51.6%(16/31).CR在恶性间皮瘤诊断中的灵敏度为81.8%(9/11),特异度为83.9%(26/31).MC在恶性间皮瘤诊断中的灵敏度为72.7%(8/11),特异度为77.4%(24/31).CEA在胸膜转移性肺腺癌诊断中的灵敏度为74.2%(23/31),特异度为90.9%(10/11).TTF-1在胸膜转移性肺腺癌诊断中的灵敏度为77.4%(24/31),特异度为90.9%(10/11).[结论]胸腔积液脱落细胞的TTF-1、CEA、VIM、CR和MC在恶性胸膜间皮瘤和胸膜转移性肺腺癌的鉴别诊断具有较高应用价值.