AgNOR定量分析在气管镜刷片及痰涂片细胞学辅助诊断中的意义

目的:利用核仁组成区技术(AgNOR)区分良性、中～重度不典型增生及恶性细胞;并探讨AgNOR分型与癌细胞类型的关系.方法:应用胶银染色技术检测259例气管镜刷片及痰涂片.结果:良性细胞均数(2.94±0.74)与恶性细胞均数(9.96±2.46),差异极显著(P<0.001),说明产生假阳性的机会很小.良性细胞与中度不典型增生细胞均数(3.85±0.65)和重度不典型增生细胞均数(5.36±0.95)差异极显著(P<0.001),有助于识别可疑癌细胞,鳞状细胞癌与腺癌和小细胞癌,腺癌与小细胞癌间差异显著(P<0.05),提示癌细胞的类型不同,AgNOR类型也有差异.AgNOR在腺癌细胞中颗粒粗大,色深;在鳞癌和小细胞癌中颗粒多为弥散型,细小,色浅.用AgNOR计数标准判断良恶性,其敏感性为97.1%,特异性为95.4%.结论:细胞学普通染色诊断困难时,AgNOR银染技术可以辅助诊断.AgNOR分型与癌细胞类型有显著相关性(P<0.05).

Significance of AgNOR Quantitative Analysis in Cytological Diagnosis of Scrubbing Slides of Tracheal Microscope and Smearing Slides of Sputa

Objective:To identify cells of benign from those of moderate and severe atypical hyperplasia and malignant by AgNORs technique.Methods:Ag staining was used in the smears of 259 cases.Results:Mean difference between benign group and malignant group was obvious(P<0.001).Rate of false positivity was low.Mean difference between benign cells,moderate and severe atypical hyperplasia cells and malignant cells was clear(P<0.001).To identify suspicious cancer cells was easy.There was also discrepancy either between squamous cancer cell and adenocarcinoma cell or between squamous cancer cell and small cell cancer.This difference also existed in adenocarcinoma cell and small cell carcer(P<0.05).Particles were bigger and stronger in adenocarcinoma than those in squamous cancer cell and small cell cancer.There was obvious relation between types of AgNOR particles and those of cancer cell.AgNOR sensitivity and specificity were 97.1% and 95.4% respectively by AgNOR count criterion.Conclusions:AgNOR technigue can help make diagnosis for which it is difficult to do so by routine staining.The types of cancer cell and AgNOR are correlative(P<0.05).