The Value Of Automatic DNA Image Cytometry And Multicriteria Detection In The Diagnosis Of Pleural Effusion

Objective: To observe the value of Automatic DNA Image Cytometry and multicriteria detection in the diagnosis of pleural effusion.Methods: Pleural effusion samples were collected from 58 patients (23men, 35women) with a median age of 47.5 years (range, 14-86years) in Respiratory department of Wuhan union hospital. We made two smears for every sample, all of which were made routine Wright's-Giemsa's staining. Each case was made a fluid based lamellar smear by cytospin, which was stained with Feulgen's stain solution. We invited two experts of cytopathology to make the diagnosis of the routine cytology examination. The smears stained by Feulgen-Thionin were analyzed by Automatic DNA Image Cytometry which was supplied by Wuhan Landing Medical High-tech limited company. At the same time we also collected the clinical materials include the smoking history, the past history, the CEA level both in the blood and in the pleural fluids, adenosine deaminase , lactate dehydrogenase and so on.Result: In the DNA ploidy analysis of cell, the content of DNA is usually expressed in'C', 1c means half of the average content of the cell nucleus DNA of normal diploidy cell mass in the G0/G1 stage of cell cycle. The cell in G0/G1 stage is 2c cell, and the cell in G2/M stage is 4c cell[1, 2]. The diagnostic criteria of malignant effusion we used was: The aneuploidy cell between 2.2c and 3.8c form a peak, or the DNA content of 3 or more cell exceeds 5c, or the proportion of 4c cell was more than 10% of the total cells. If one or more of the above criteria were satisfied, the case was diagnosed as malignant pleural fluid. We got a sensitivity of 94.12% and a specificity of 87.8%, positive predictive value of 76.19%, negative predictive value of 97.3%, correct rate of 89.66% with the the Automatic DNA image analysis system. The sensitivity and specificity of the routine cytologic diagnosis were 82.35% and 92.15%. If we connect the Automatic DNA image analysis system and the routine cytologic diagnosis, we can get a sensitivity and specificity of 100% and 82.93%. The level of serum CEA in the malignant group (33.24mmol/L) is much higher than in the benign group (1.39mmpl/L), there is significant statistics difference between them (P<0.000). The level of CEA in pleural effusion in the malignant group (270.44mmol/L) is much higher than in the benign group (0.94mmol/L), P<0.000, the statistics difference was obvious. The value of pleural effusion CEA/serum CEA was higher in malignant group (13.30) than in the benign group (0.89), there is significant statistic difference between the two groups. If we set the level of CEA in bood at the point of 4.045mmlol/l we can get a specialty of 100%. We did not find any correlation between the number of aneuploidy and the level of CEA in either serum or pleural effusions in our study, and smoking does not correlate with malignant pleural effusions.Conclusion: The Automatic DNA Image Cytometry is of very important value in the diagnosis and the differential diagnosis of benigh and the malignant pleural fluids; the level of CEA in both serum and pleural fluids and the value of pleural fluid CEA/serum CEA are all well markers of the diagnosis of malignant pleural effusions; Combined with the routine cytology and other clinical examination facility, we can deeply distinct the cause of disease and improve the accuracy and the sensitivity of the diagnosis.