背景:本研究旨在评估流式细胞术(FCM)检测浆液性积液中恶性上皮细胞的诊断准确性。
方法:流式细胞术评估96个浆液(86个腹水,10胸膜)是通过使用上皮细胞粘附分子(EpCAM)(在所有96个液体中)和MUC-1(在40个液体的亚组中)作为上皮标志物,CD45和CD14作为白细胞标志物进行的。通过选择性门控计算CD14和CD45双阴性群体中EpCAM阳性和MUC-1阳性的百分比。然后将研究结果与定义的黄金标准标准相关联。
结果:灵敏度,特异性,阳性预测值(PPV),负预测值(NPV),EpCAM的诊断准确率为92.06%,96.96%,98.31%,86.48%,93.75%,分别,而MUC-1的比例为79.16%,93.75%,95%,71.4%,85%,分别。敏感性,特异性,PPV,NPV,EpCAM和MUC-1双重阳性的诊断准确率为83.3%,100%,100%,80%,分别为90%。将FCM与细胞形态学相结合,特异性,PPV,NPV,诊断准确率都大大提高到95.3%,100%,100%,91.4%,和96.8%,分别。
结论:这项研究强调了彩色流式细胞术分析在检测积液中上皮性恶性肿瘤中的重要性,特别是在属于不确定意义的非典型性和可疑恶性肿瘤类别的病例中,以及在临床上强烈怀疑恶性肿瘤且液体细胞学检查阴性的病例中。我们建议在常规临床实践中对该特定亚组患者联合使用FCM和细胞学检查,以快速准确地报告。
BACKGROUND: This study aims to evaluate diagnostic accuracy of flow cytometry (FCM) in detecting malignant epithelial cells in serous effusions.
METHODS: Flow cytometric assessment of 96 serous fluids (86 ascitic, 10 pleural) was performed by using epithelial cell adhesion molecule (EpCAM) (in all 96 fluids) and MUC-1 (in a subgroup of 40 fluids) as epithelial markers and CD45 and CD14 as leucocyte markers. The percentage of EpCAM positivity and MUC-1 positivity was calculated in the CD14 and CD45 dual negative population by selective gating. The findings were then correlated with the defined gold standard criteria.
RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy for EpCAM was found to be 92.06%, 96.96%, 98.31%, 86.48%, and 93.75%, respectively, while that for MUC-1 was 79.16%, 93.75%, 95%, 71.4%, and 85%, respectively. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for dual positivity for EpCAM and MUC-1 was found to be 83.3%, 100%, 100%, 80%, and 90% respectively. On combining FCM with cytomorphology the sensitivity, specificity, PPV, NPV, and diagnostic accuracy all increased greatly to 95.3%, 100%, 100%, 91.4%, and 96.8%, respectively.
CONCLUSIONS: This study highlights the importance of multicolored flow cytometric analysis in detecting epithelial malignancies in effusions specially in cases belonging to the atypia of undetermined significance and suspicious for malignancy categories and in cases with strong clinical suspicion of malignancy with negative fluid cytology. We recommend the combined use of FCM and cytology for this specific subgroup of patients in routine clinical practice for fast and accurate reporting.