浆膜腔积液细胞病理学检查在卵巢高级别浆液性癌诊断中的效能分析

doi:10.3969/j.issn.1004-616x.2025.03.009

癌变·畸变·突变 ›› 2025, Vol. 37 ›› Issue (3): 228-233,251.doi: 10.3969/j.issn.1004-616x.2025.03.009

• 肿瘤防治 • 上一篇

浆膜腔积液细胞病理学检查在卵巢高级别浆液性癌诊断中的效能分析

崔潆¹, 赵琳琳¹, 于婧², 赵焕¹, 张智慧¹, 郭会芹^1,2

1. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院, 病理科, 北京 100021;
2. 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院, 廊坊院区病理科, 河北廊坊 065001

收稿日期:2025-01-24 修回日期:2025-03-28 发布日期:2025-06-13
通讯作者: 郭会芹
作者简介:崔潆，E-mail：cy199910001@163.com。
基金资助:
中国医学科学院临床与转化医学研究专项(2022-I2M-C&T-B-082)

Efficacy of cytopathological examination using serous effusion in the diagnosis of high-grade ovarian serous carcinoma

CUI Ying¹, ZHAO Linlin¹, YU Jing², ZHAO Huan¹, ZHANG Zhihui¹, GUO Huiqin^1,2

1. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021;
2. Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Langfang Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Langfang 065001, Hebei, China

Received:2025-01-24 Revised:2025-03-28 Published:2025-06-13

摘要/Abstract

摘要： 目的：评价浆膜腔积液细胞病理学检查联合PAX8、WT-1、p53、p16免疫细胞化学染色对卵巢高级别浆液性癌的诊断效能，确定适合卵巢高级别浆液性癌的浆膜腔积液细胞病理学诊断标准。方法：以128例浆膜腔积液细胞病理学诊断为腺癌且组织病理诊断为卵巢高级别浆液性癌的晚期(III-IV期)患者为研究对象，对患者浆膜腔积液细胞蜡块切片进行免疫细胞化学染色，采用Kappa检验分析PAX8、WT-1、p53、p16在浆膜腔积液与卵巢原发灶中的一致性，以PAX8阳性/WT-1阳性/p53异常表达作为高级别浆液性癌的诊断标准，统计能够分型诊断的病例数。结果：PAX8 的表达水平在浆膜腔积液细胞蜡块和原发灶的一致率为98.31%，Kappa值为0.944(P<0.05)；WT-1一致率为84.43%，Kappa值为0.783(P<0.05)；p53和p16一致率分别为71.9%、73.33%，Kappa值分别为0.547、0.478(P<0.05)。以PAX8阳性/WT-1阳性/p53异常表达为诊断标准时，浆膜腔积液细胞学对高级别浆液性癌的诊断率为67.97%；将p53过表达阈值从70%下调至60%时，可新增13例诊断，诊断率提升至78.13%；在此基础上，当p53为野生型时，结合肿瘤细胞的高级别形态和p16，诊断率可提升至85.94%。结论：PAX8和WT-1在浆膜腔积液样本和卵巢原发灶中的表达一致性较好，而p53和p16表达具有中等的一致性。在浆膜腔积液样本中，通过将p53过表达阳性阈值降低至60%可提高卵巢高级别浆液性癌的诊断率；在p53野生型，当PAX8阳性/WT-1阳性/p16弥漫强阳时，结合肿瘤细胞的高级别形态也可作出提示高级别浆液性癌的诊断。

关键词: 高级别浆液性癌, 浆膜腔积液, 细胞病理学, 卵巢癌, 免疫细胞化学

Abstract: OBJECTIVE： This study evaluated the concordance between immunocytochemistry(ICC) of PAX8，WT-1，p53 and p16 in effusion sample and immunohistochemistry (IHC) of primary ovarian tumors； assessed the diagnostic ability of the markers for diagnosing high-grade serous ovarian cancer(HGSOC)； and developed specific criteria for effusion cytology. METHODS： This study included 128 patients with effusion cytology diagnosed as adenocarcinoma and histopathologically confirmed for stage III-IV HGSOC. PAX8，WT-1 positivity，and p53 mutation status were conducted as diagnostic criteria for HGSOC. The Kappa test assessed the concordance between PAX8， WT-1， p53， and p16 expression in serous effusion samples and primary ovarian tumors. The number of definitively classified cases was recorded. RESULTS： The concordance rate of PAX8 expression between effusion and primary sites was 98.31%，with a Kappa value of 0.944 (P<0.05). For WT-1，the concordance rate was 84.43% and the Kappa value was 0.783 (P<0.05). The concordance rates for p53 and p16 were 71.9% and 73.33%，respectively，with corresponding Kappa values of 0.547 and 0.478 (P< 0.05). When using PAX8 positivity，WT-1 positivity，and p53 abnormal expression as diagnostic criteria，the diagnostic rate for HGSOC was 67.97%. Lowering the threshold for p53 overexpression in effusion samples from 70% to 60% enabled the identification of 13 additional cases， increasing the diagnostic rate to 78.13% . Furthermore， combining PAX8 positivity， WT-1 positivity， p53 wild type (with a 60% overexpression threshold)，and diffuse strong p16 positivity with high-grade morphological features of tumor cells raised the diagnostic rate for HGSOC in serous cavity effusion to 85.94%. CONCLUSION： The expression patterns of PAX8 and WT-1 in effusion samples were found to be consistent with those in primary ovarian tumors， whereas expression of p53 and p16 showed only moderate consistency. By lowering the positivity threshold for p53 overexpression from 70% to 60% ， the diagnostic criteria of PAX8 positivity， WT-1 positivity， p53 abnormal expression enhanced the detection rate of HGSOC in effusion cytopathology. Additionally，when p53 was wild-type but PAX8-positive/WT-1-positive/p16 diffusely positive，coupled with high-grade morphological features of tumor cells，the diagnosis of HGSOC was better indicated.

Key words: high-grade serous ovarian cancer, serous cavity effusion, cytopathology, ovarian cancer, immunocytochemistry

中图分类号:

R365

崔潆, 赵琳琳, 于婧, 赵焕, 张智慧, 郭会芹. 浆膜腔积液细胞病理学检查在卵巢高级别浆液性癌诊断中的效能分析[J]. 癌变·畸变·突变, 2025, 37(3): 228-233,251.

CUI Ying, ZHAO Linlin, YU Jing, ZHAO Huan, ZHANG Zhihui, GUO Huiqin. Efficacy of cytopathological examination using serous effusion in the diagnosis of high-grade ovarian serous carcinoma[J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2025, 37(3): 228-233,251.

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浆膜腔积液细胞病理学检查在卵巢高级别浆液性癌诊断中的效能分析

Efficacy of cytopathological examination using serous effusion in the diagnosis of high-grade ovarian serous carcinoma

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