Clinical Value Of Cell Block Immunocy Tochemistry In Diagnosis Of Pleural Effusions

Objective:immunocytochemistry staining was used to detect the expression ofthyroid transcription factor-1(TTF-1), carcino embryonic antigen(CEA),cytokeratin7(CK7), cytokeratin20(CK20) and p63in cell blocks of pleuraleffusion and to disclose its clinical value of differentiating benign andmalignant pleural effusion, determining the tumor tissue typing and tissuesources.Methods:We collected specimens in January2012-2014April pathological cells inthe first hospital of Jilin university diagnosed as malignant pleural effusionwith Pathological diagnosis of72cases of patients with pleural effusion,including50cases of malignant pleural effusion as malignant group,22casesof suspicious malignant pleural as suspicious groups, while collecting20casesof benign pleural effusion as benign group. Pleural effusion cells were collectedby centrifugation, paraffin embedding was prepared for block of cells, usingEliVision method for immunohistochemical staining. Detected the expressionof TTF-1, CEA, CK7, CK20and p63in epithelial cells in pleural effusionsunder the microscope.Results:1. The aspect of differentiation benign and malignant of pleural effusion:the positive rate of TTF-1, CEA and CK7in50cases of malignant pleuraleffusion epithelial tumor cells was58.0%,66.0%,76.0%respectively,significantly higher than benign pleural effusion(p<0.05); and the positive rate of CK20and p63was2.0%and14.0, differentially expressed in malignantgroup and benign group was not statistically significant(p>0.05).2. The aspect of determination the tissue typing of tumor cells: The resultof Immunocytochemistry in malignant group, suspicious group and benigngroup comparison with pathological diagnosis: the positive rate of TTF-1, CEAand CK7in lung adenocarcinoma was80.8%,88.5%,96.2%, respectively,while CK20and p63in lung adenocarcinoma were no expression; the positiverate of p63in8cases squamous cell carcinoma was87.5%, while the TTF-1,CEA, CK7and CK20no expression in lung squamous cell carcinoma.3. The aspect of determination the tissue origin of tumor cells: TTF-1have43cases that were expressed in61cases of lung cancer, CEA have46casesthat were expressed, CK7have51cases that were expressed, p63have7casesthat were expressed, CK20no expression. The positive rate of CK7in5casesbreast cancer was100%; CEA were expressed in2cases gastric cancer, CK20was expressed in only1case, TTF-1, CK7and p63was no expression; TTF-1,CEA, CK7, CK20and p63was no expression in1case pancreatic cancer and2cases non-Hodgkin’s lymphoma.4. The comparation of sensitivity, specificity and accuracy: the comparedresults of sensitivity, specificity and accuracy of TTF-1, CEA, CK7, CK20andp63in the diagnosis of pleural effusion: CK7has a good sensitivity, specificityand accuracy in the diagnosis of pleural effusion(78.9%,95.2.0%,82.6%). Thesensitivity, specificity and accuracy of TTF-1, CEA and CK7single andcombined in lung adenocarcinoma were compared: TTF-1and CK7twomarkers combined detection with better sensitivity,specificity and accuracy(100%,82.5.0%,92.4%).5. Compared the examination positive rate of cell pathologicalmorphology and immunocytochemistry: the positive rate of cell pathological morphological was54.3%(50/92), the positive rate of immunocytochemistrywas72.8%(67/92), the positive rate of combination was75.0%(69/92)(χ2=10.78p<0.05),statistically significant difference between thethree. However, the combination of the two compared with singleimmunocytochemistry, the difference was not statistically significant(p>0.05).Conclusion:1. The sensitivity,specificity and accuracy of TTF-1CEA and CK7indiagnosis of malignant pleural effusion were higher, so the combination ofTTF-1, CEA, CK7can differentiate between benign and malignant pleuraleffusion and can help cell pathological morphology examination improve thepositive rate of malignant pleural effusion.2. Immunocytochemistry can identify the adenocarcinoma and squamouscell of pleural effusion. TTF-1, CEA and CK7can be used as specific marker todiagnose lung adenocarcinoma; p63can be used as specific marker to diagnoselung squamous.3. The combination of markers can determine the tissue origin of tumorcells: TTF-1has a higher expression in lung adenocarcinoma,CEA wasexpressed in lung adenocarcinoma and gastric carcinoma, CK7was expressedin lung adenocarcinoma and breast cancer, CK20was expressed in gastriccancer only, p63was expressed in squamous cells.