| Objective：Find a high sensitivity and specificity methods to improve thepositive detection rates in earlier tumor by DNA ploidy analysis combined thecytology and CEA detection in diagnostic benign and malignant pleuraleffusion.Methods：The samples collected from April2011to November2011during the First Hospital of Jilin University Respiratory Medicine, andeventually confirm the diagnosis of105cases of patients with pleural effusionspecimens, including56cases of malignant pleural effusion group,49cases ofbenign pleural effusion group. Prepared2smears by the Thin Prep producermethod and cytospin mechanism: Papanicolaou stain, microscopic diagnosis oftumor cell morphology, Feulgen-Thionin stain, and DNA ploidy analyzercellular DNA image analysis, the application of electrochemiluminescenceassay in pleural fluid carcinoembryonic antigen (CEA) concentration. Theresults of malignant pleural effusion is: using cytology microscope to find thesuspicious tumor cells or to find the tumor cells; DNA ploidy analysis in one ofthe following conditions for malignant pleural effusion which is:①three ormore than three aneuploidy cells at5c,②no DNA aneuploid cells,but have aaneuploid peak,③The4c cells accounted for10%of the total number of themeasured cells,④a greater than9C of aneuploid cell; CEA detectableconcentration>3.4ng/ml determined to be malignant effusion. These resultsare in the compliance control and the pathological diagnosis and using SPSS17.0software for statistical analysis.Results:1. The positive rate of the three testing methods:In105cases of pleural effusion,58cases of DNA ploidy analysis tested was abnormal and the positiverate was55.24%(58/105),48cases of cytology find the suspicious tumor cellsor to find the tumor cells,the positive rate was45.71%(48/105),39cases ofpleural fluid CEA test concentration>3.4ng/ml, the positive rate was37.14%(39/105). To compare the positive rates: DNA ploidy analysis> cytology>CEA, The differences was statistically significant compared with the positiverate of CEA (P <0.05).2. The sensitivity, specificity, and accuracy of the three methods: In thebenign and malignant pleural effusion group, the sensitivity of DNA ploidyanalysis was92.86%(52/56) and the specificity was87.76%(43/49), theaccuracy was90.48%(95/105); the sensitivity of cytology was78.57%(44/56)and the specificity was91.84%(45/49), the accuracy was84.76%(89/105); thesensitivity of CEA was62.50%(35/56) and the specificity was81.63%(40/49),the accuracy was71.43%(75/105). The sensitivity and the accuracy of DNAploidy analysis were higher than the cytology and CEA, the differences werestatistically significant (P <0.05) except that compared with the accuracy of thecytology.3. The positive predictive value, negative predictive value and Youdenindex of three methods: the positive predictive value of DNA ploidy analysiswas89.66%(52/58), negative predictive value was91.49%(43/47), Youdenindex was0.81; the positive predictive value of cytology was91.67%(43/47)and negative predictive value was78.95%(45/57), Youden index was0.70; thepositive predictive value of CEA in pleural effusion was79.55%(35/44),negative predictive value was65.57%(40/61), Youden index was0.44. Thenegative predictive value, Youden index of DNA ploidy analysis were higherthan the cytology and CEA, and the differences of negative predictive valuewere statistically significant (P <0.05),compared with Youden index of. pleuraleffusion CEA have statistically significant (P <0.05).These data indicate that the random error in DNA ploidy analysis was small, sensitivity was higher andresults are reliable. The Kappa value of DNA ploidy analysis were higher thanthe method of cytology and CEA, indicating that DNA ploidy analysis have abetter clinical value.4. Combined detection： The sensitivity of combined detection amongDNA ploidy analysis, cytology and CEA is high up to99.43%, but specificitywas lower, only65.79%；the combination of DNA ploidy analysis and cytology(sensitivity was98.47%and specificity was80.60%, Youden index was0.79accuracy was90.48%)，are valuable in the diagnosis of malignant pleuraleffusion. the diagnostic value was wonderful.Conclusion:1. Compared with cytology and pleural effusion CEA, DNA ploidyanalysis have a higher positive rate, the sensitivity was (92.86%), higher thanthe cytology (78.57%) and CEA (53.53%). DNA ploidy analysis is a betterindicator of the clinical differential diagnosis of benign and malignant pleuraleffusion.2. The sensitivity (98.29%) and specificity (80.60%) of DNA ploidyanalysis and cytology combined detection were superior to the combined withCEA, and combination testing can compensate for sensitivity of cytology andpleural effusion CEA shortage problem. |
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