背景与目的浆膜腔积液是中晚期肺癌患者常见并发症,其出现往往提示肿瘤已发生胸膜或其他浆膜转移。准确诊断积液中的肿瘤细胞并进行病理分型,对指导临床治疗至关重要。然而,单纯依赖细胞形态学诊断存在局限性,尤其在不典型病例中易出现...背景与目的浆膜腔积液是中晚期肺癌患者常见并发症,其出现往往提示肿瘤已发生胸膜或其他浆膜转移。准确诊断积液中的肿瘤细胞并进行病理分型,对指导临床治疗至关重要。然而,单纯依赖细胞形态学诊断存在局限性,尤其在不典型病例中易出现不确定性诊断。《浆膜腔积液细胞病理学国际报告系统》(The International System for Serous Fluid Cytopathology,TIS)提出了形态学与辅助技术相结合的标准化分层诊断框架,但其在国内肺癌人群中的临床应用价值尚缺乏大规模验证。本研究旨在基于大样本肺癌病例,系统性评估TIS系统在肺癌浆膜腔积液诊断与分型中的效能。方法回顾性纳入2018年1月至2023年12月中国医学科学院肿瘤医院的1274例浆膜腔积液样本,其均来源于组织病理学和/或临床病史确诊的肺癌患者。严格遵循TIS系统诊断流程,先进行形态学评估并分级(Ⅰ-Ⅴ级),对部分形态学不确定(Ⅲ、Ⅳ级)及Ⅴ级病例,利用细胞蜡块进行免疫细胞化学(immunocytochemistry,ICC)检测,综合确定最终诊断级别并进行肿瘤分型与起源判断。统计分析形态学初诊与联合ICC诊断一致性、分级变化趋势及ICC检测在病理分型与溯源中的临床价值。结果形态学初诊中,83.1%(1059/1274)的病例直接诊断为恶性(V级),12.3%(157/1274)的病例为不确定性诊断(Ⅲ或Ⅳ级)。对69例接受ICC检测的病例进一步分析显示,升级诊断率为85.5%(59/69),其中Ⅳ级病例的升级比例(89.6%,43/48)高于Ⅲ级(76.2%,16/21);7.2%(5/69)的Ⅲ级病例降级为良性(Ⅱ级),另7.2%(5/69)因细胞量不足或分化差而维持原级,表明ICC可显著提升肺癌浆膜腔积液不确定性诊断的明确性。在最终诊断恶性的病例中,ICC对542例进行分型与溯源,533例(98.3%)实现精准病理分型(腺癌86.7%、小细胞癌4.4%、鳞癌3.9%),510例(94.0%)明确为肺来源。关键ICC标志物表达谱分析显示,浆膜腔积液中肺腺癌甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)与Napsin A呈高表达,阳性率分别为93.0%和76.2%;肺鳞癌特征性表达P40和P63,阳性率分别为60.0%和73.7%;小细胞癌强表达Syn与CD56,阳性率分别达87.0%和81.8%。通过采用一组互补抗体进行综合判读,可以对形态学初诊报告进行验证与补充,为亚型鉴别提供可靠依据。结论TIS系统构建的“形态学初诊、辅助技术确证”分层诊断路径,能显著提高肺癌浆膜腔积液诊断的准确性,有效优化不确定性病例分流,实现高精度的病理分型与组织起源判断。建议在临床实践中推广应用TIS系统,以促进浆膜腔积液细胞病理学诊断的规范化与精准化。展开更多
To understand the needs of public health institutions in Zhejiang Province,China for public health personnel,and provide basis for training public health personnel.Methods:512 public health institutions in Zhejiang Pr...To understand the needs of public health institutions in Zhejiang Province,China for public health personnel,and provide basis for training public health personnel.Methods:512 public health institutions in Zhejiang Province were randomly selected from different levels and regions,and the number of ublic health professional and the demand for professional ability were investigated by questionnaire.Results:The preventive medicine personnel in public health institutions in Zhejiang Province are insufficient;There is a certain disjunction or dislocation between the abilities and needs of public health professional;The way of continuing education for public health professional is single and the opportunities are few.Conclusion:Zhejiang Province should appropriately expand the enrollment of preventive medicine majors,especially high-level preventive medicine talents,deepen the education and teaching reform of preventive medicine majors,and strengthen the continuing education and training of public health professional to meet the needs of public health services after the COVID-19 epidemic.展开更多
文摘背景与目的浆膜腔积液是中晚期肺癌患者常见并发症,其出现往往提示肿瘤已发生胸膜或其他浆膜转移。准确诊断积液中的肿瘤细胞并进行病理分型,对指导临床治疗至关重要。然而,单纯依赖细胞形态学诊断存在局限性,尤其在不典型病例中易出现不确定性诊断。《浆膜腔积液细胞病理学国际报告系统》(The International System for Serous Fluid Cytopathology,TIS)提出了形态学与辅助技术相结合的标准化分层诊断框架,但其在国内肺癌人群中的临床应用价值尚缺乏大规模验证。本研究旨在基于大样本肺癌病例,系统性评估TIS系统在肺癌浆膜腔积液诊断与分型中的效能。方法回顾性纳入2018年1月至2023年12月中国医学科学院肿瘤医院的1274例浆膜腔积液样本,其均来源于组织病理学和/或临床病史确诊的肺癌患者。严格遵循TIS系统诊断流程,先进行形态学评估并分级(Ⅰ-Ⅴ级),对部分形态学不确定(Ⅲ、Ⅳ级)及Ⅴ级病例,利用细胞蜡块进行免疫细胞化学(immunocytochemistry,ICC)检测,综合确定最终诊断级别并进行肿瘤分型与起源判断。统计分析形态学初诊与联合ICC诊断一致性、分级变化趋势及ICC检测在病理分型与溯源中的临床价值。结果形态学初诊中,83.1%(1059/1274)的病例直接诊断为恶性(V级),12.3%(157/1274)的病例为不确定性诊断(Ⅲ或Ⅳ级)。对69例接受ICC检测的病例进一步分析显示,升级诊断率为85.5%(59/69),其中Ⅳ级病例的升级比例(89.6%,43/48)高于Ⅲ级(76.2%,16/21);7.2%(5/69)的Ⅲ级病例降级为良性(Ⅱ级),另7.2%(5/69)因细胞量不足或分化差而维持原级,表明ICC可显著提升肺癌浆膜腔积液不确定性诊断的明确性。在最终诊断恶性的病例中,ICC对542例进行分型与溯源,533例(98.3%)实现精准病理分型(腺癌86.7%、小细胞癌4.4%、鳞癌3.9%),510例(94.0%)明确为肺来源。关键ICC标志物表达谱分析显示,浆膜腔积液中肺腺癌甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)与Napsin A呈高表达,阳性率分别为93.0%和76.2%;肺鳞癌特征性表达P40和P63,阳性率分别为60.0%和73.7%;小细胞癌强表达Syn与CD56,阳性率分别达87.0%和81.8%。通过采用一组互补抗体进行综合判读,可以对形态学初诊报告进行验证与补充,为亚型鉴别提供可靠依据。结论TIS系统构建的“形态学初诊、辅助技术确证”分层诊断路径,能显著提高肺癌浆膜腔积液诊断的准确性,有效优化不确定性病例分流,实现高精度的病理分型与组织起源判断。建议在临床实践中推广应用TIS系统,以促进浆膜腔积液细胞病理学诊断的规范化与精准化。
基金supported by Zhejiang Soft Science Research Program(2021C35016)。
文摘To understand the needs of public health institutions in Zhejiang Province,China for public health personnel,and provide basis for training public health personnel.Methods:512 public health institutions in Zhejiang Province were randomly selected from different levels and regions,and the number of ublic health professional and the demand for professional ability were investigated by questionnaire.Results:The preventive medicine personnel in public health institutions in Zhejiang Province are insufficient;There is a certain disjunction or dislocation between the abilities and needs of public health professional;The way of continuing education for public health professional is single and the opportunities are few.Conclusion:Zhejiang Province should appropriately expand the enrollment of preventive medicine majors,especially high-level preventive medicine talents,deepen the education and teaching reform of preventive medicine majors,and strengthen the continuing education and training of public health professional to meet the needs of public health services after the COVID-19 epidemic.
