B超引导下细针穿刺细胞块对胰腺占位性病变的诊断价值(1)
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【摘要】 目的 探讨术前细针穿刺细胞块对胰腺占位性病变的诊断价值。方法 回顾分析本院2005年1月至2010年6月收治的胰腺占位性病变83例,术前均行B超引导下穿刺作细胞学涂片及细胞块检查,并与最终病理诊断作对比研究。结果 细胞学涂片和细胞块切片的准确性分别为89.2%、97.6%,两者比较差异显著(P<0.05)。细胞块诊断实性假乳头状瘤和胰腺内分泌肿瘤的准确性均为100%。结论 术前穿刺细胞块检查可提高诊断的准确性。细胞块结合免疫组化分析,有助于提高胰腺肿物的分型,尤其是实性假乳头状瘤和胰腺内分泌肿瘤的检出率,减少漏诊和误诊。
【关键词】 B超; 细针穿刺; 细胞块; 免疫组化; 胰腺肿瘤
Diagnosis value of fine needle aspiration of cell block guided on ultrasound B on pancreas lesion
ZHOU Li, CHEN Bing,MA Guang-zhen,et al. Department of Pathology,the Second People's Hospital of Liaocheng,Linqing 252600,China
【Abstract】 Objective To investigate the diagnostic value of fine needle aspiration cell block to the pancreatic lesion.Methods From January 2005 to June 2010 there were 83 patients with pancreatic lesion were selected.Preoperatively they underwent ultrasound guidedfine needle aspiration cytology(FNAC) and cell block,and the diagnosis results of them were compared with the final diagnosis available.Results Accuracy of FNAC and cell block were 89.2%,97.6%,there was a statistic difference(P<0.05).The accuracy of cell block for Solid pseudopapillary tumor of the pancreas (SPTP) and pancreatic endocrine tumor were100%. Conclusion Ultrasound guided fine needle aspiration of cell block of the pancreas may increase the accuracy of pancreatic lesion.The combination of IHC staining to the cell block may have a high applied value to histological typing in pancreatic lesion, especially for SPTP and pancreatic endocrine tumor.
【Key words】Ultrasound B;Fine needle aspiration;Cell block;Immunohistochemistry staining;Pancreatic neoplasms
胰腺占位性病变临床常见,其治疗方法和患者预后主要取决于病变性质。超声引导下经皮细针穿刺(ultrasound guided transcutaneous fine needle aspiration,US- FNA)的应用大大提高了胰腺肿瘤的诊断率和手术切除率,本文对83例胰腺占位患者进行回顾性分析,对比针吸细胞学(fine needle aspiration cytology, FNAC)与细胞块诊断结果,探讨细胞块对胰腺占位性病变的诊断价值。
1 资料与方法
1.1 一般资料 2003年1月至2010年6月收治的胰腺占位性病变83例患者,均经病理组织学证实。其中男52例,女21例;年龄13~71岁,平均42.5岁,其中胰头部病变61例,胰体尾部病变22例。肿物最大径3~21 cm。
1.2 方法
1.2.1 B超引导下定位穿刺,选择胰腺病变最大径处或明显回声异常处作为穿刺点,同时尽可能避开胃及横结肠。穿刺部位常规消毒,2%利多卡因局部浸润麻醉;使用一次性7号加长穿刺针,进行负压针吸,针尖在瘤体内上下提插,直到针坐后孔内见到抽出物后拔针,每例穿刺2-3次。吸出物放于载玻片上,制成厚薄均匀的涂片,迅速放入95%乙醇固定,HE染色,行细胞学检查。细胞块制作是将吸出物置于载玻片上,用5 ml注射器吸取少量95%乙醇先后滴于吸出物周围及中央,使吸出物初步固定并聚集成小团或球形,将其轻轻推入AF液固定,最后细胞块进行脱水、透明、浸蜡、HE染色 ......
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