目的：探讨利用BD TriPath液基细胞学联合免疫细胞化学对疑难肺腺癌转移胸腔积液的诊断价值。方法：对临床初次送检的31例胸腔积液标本，采用BD TriPath液基细胞制片染色仪，每例制片5张，1张巴氏染色用于细胞学诊断，其余4张行免疫细胞化学染色分别检测癌胚抗原(carcinoembryonic antigen，CEA)、甲状腺转录因子1(thyroid transcription factor 1，TTF-1)、间皮细胞抗原(mesothelial cell，MC)、钙结合蛋白(calretinin，CR)的表达。结果：呼吸科门诊或住院患者送检的31例胸腔积液，经证实肺腺癌转移的胸腔积液24例，7例未见恶性肿瘤细胞。31例胸腔积液经免疫细胞化学染色显示，CEA、TTF-1鉴别腺癌细胞的灵敏度分别为79.2%，66.7%，特异度为96.8%，100%；MC，CR鉴别间皮细胞的灵敏度分别为93.5%，100%，特异度为95.8%，83.3%。两组抗体在腺癌细胞及间皮细胞者的表达差异有显著统计学意义(P<0.01)。单独BD TriPath液基细胞学可明确诊断肺腺癌转移15例、未见恶性肿瘤细胞6例，10例未能明确诊断。如果结合免疫细胞化学可明确诊断肺腺癌转移21例、未见恶性肿瘤细胞6例，仅4例不能明确诊断，两者相结合使阳性检出率显著提高(P<0.05)。结论：基于BD TriPath液基细胞薄片上的免疫细胞化学有助于提高对胸腔积液中转移性肺腺癌细胞的诊断。CEA，TTF-1，MC，CR联合应用可有效辅助细胞学鉴别肺腺癌细胞及间皮细胞，值得推广应用。
Application of BD TriPath liquid-based cytologic test and immunocytochemistry in diagnosis of lung adenocarcinoma in pleural effusion
Objective: To investigate the application value of BD TriPath liquid-based cytologic test (LCT) combined with immunocytochemistry (ICC) technology in diagnosis and differential diagnosis of lung adenocarcinoma in complicated pleural effusion. Methods: Totally 31 first-time examinational pleural effusion were detected by LCT. Furthermore, ICC was performed with carcinoembryonic antigen (CEA), thyroid transcription factor 1 (TTF-1), mesothelial cell (MC) and calretinin (CR) in all of the specimens. Results: Among 31 cases of pleural effusion to be tested, 24 cases of pleural effusion were from lung adenocarcinoma transfer and 7 cases without malignant cell. In diagnose of metastatic lung adenocarcinoma, the sensitivity of CEA and TTF-1 was 79.2%, 66.7% and the specificity was 96.8%, 100% respectively. The sensitivity of MC and CR for mesothelial cell was 93.5%, 100% and the specificity was 95.8%, 83.3% respectively. The difference was statistically significant (P<0.01). If diagnosed by LCT alone, 15 cases of lung adenocarcinoma and 6 reactive effusions were conformed, 10 cases were indeterminate. However, if LCT combined with ICC, 21 cases of lung adenocarcinoma and 6 reactive effusion could be clearly diagnosed, only 4 cases were indeterminate, the positive detection rate increased significantly (P<0.05). Conclusion: Positive detection rate can be significantly increased by BD TriPath LCT combined with ICC in complicated pleural effusion diagnosis. A combination of CEA, TTF-1, MC and CR should be popularized in differentiate between lung adenocarcinoma cell and atypical mesothelial cell. Therefore, immunocytochemistry should be widely used in cytological diagnosis.