CD138免疫染色分析可改善慢性子宮內膜炎診斷速率


  Oct. 10, 2005 (西雅圖) - 在美國臨床病理協會的年會上有一項發表,專家指出,使用CD138免疫分析法可以改善慢性子宮內膜炎的診斷速度,同時也可以縮短病理人員在實驗室的試驗時間。
  
  慢性子宮內膜炎是發生在子宮內緣的一種發炎性病變,據悉為多種不同的微生物感染所導致;病理專家一般皆以掃描的方式對切片檢體玻片進行掃描,對原生質細胞作偵測,這些細菌的細胞原生質就是導致慢性發炎的主因。
  
  來自德州大學醫學院蓋爾維斯頓分校的Sharon Fuentes醫師表示,發現原生質細胞是一件很難的事,我們希望縮短原生質細胞的偵測時間。
  
  研究人員使用一種免疫染色法來檢測CD138,這是一種存在於細胞表面的醣蛋白,可以偵測原生質細胞的存在;子宮內膜切片檢體來自107位20到35歲之間的女性,這些患者皆被診斷出慢性子宮內膜炎,或子宮內層正常,但卻有過度分泌、脫落,或排卵障礙的現象。
  
  切片檢體皆針對CD138及胰島蛋白進行染色診斷,這類胰島蛋白可以偵測巨大細胞;巨大細胞的出現會重新組合原生質細胞,導致慢性子宮內膜炎的誤診;兩位不同的病理人員在未知既存診斷結果的情形下,對這些切片檢體進行診斷。
  
  在28位慢性子宮內炎者中,只有18位為CD 138陽性,胰島蛋白陰性,而這正是正確的診斷結果;但是,Fuentes表示,其中有10個切片檢體為CD 138陰性,但胰島蛋白陽性,而這顯示巨大細胞會誤導病理人員作出35%的誤判率。
  
  同樣的,79個良性切片檢體中,有32(40%)個被誤判為陰性,這些為CD 138免疫染色陽性,胰島蛋白陰性。
  
  Fuentes強調,高比率的陰性誤判率可能會讓患者的大量出血狀況無法判斷,也可能會導致不必要的子宮切除手術;8%的切片檢體來自子宮切除手術的樣本,而免疫染色的使用正可以增加診斷的正確性。
  
  Fuentes向Medscape表示,這些陰性誤判的案例應該已經被證實;藉著這項技術的使用,我們可以幫助患者,必要時可在臨床上以抗生素對子宮內膜炎作治療;醫師們應該考慮使用這項染色法來防止婦女們進行不必要的子宮切除手術。
  
  免疫染色可以賦予另外一項利多因素,那就是時間的節省,病理人員平均花費三分鐘來檢測傳統的hematoxylin及eosin玻片切片檢體,但是免疫染色只需要15秒;整體而言,切片檢體的分析可以由53.6分鐘縮短至5.35分鐘,也就是30倍的差別;Fuentes指出,對於病理人員而言,這獲取了時間上的效益。
  
  在這個免疫組蛋白化學(immunohistochemistry)越來越貴的時候,這項技術可以降低實驗室人員搜尋原生質細胞的時間,也可以防止非必要性手術的產生。
  
  Fuentes表示,這項研究並未接受任何商業界的資助;作者們未公佈其資金來源。

Immunostain CD138 May Improve<

By Melissa Schorr
Medscape Medical News

Oct. 10, 2005 (Seattle) — The use of CD138 immunostaining may improve the detection rate of chronic endometritis while reducing the pathologist's lab time, according to research presented here at the annual meeting of the American Society for Clinical Pathology.

Chronic endometritis, an inflammation of the uterine lining, is believed to be caused by various infectious organisms. Pathologists typically diagnose the condition by laboriously scanning slide specimens for the presence of plasma cells, which are associated with chronic inflammation.

"Finding plasma cells is difficult," lead author Sharon Fuentes, MD, a pathology resident at the University of Texas Medical Branch in Galveston, told Medscape. "We wanted to lessen the time it takes to find plasma cells."

Researchers used an immunostain for CD138, a plasma cell–surface glycoprotein, to detect the presence of plasma cells. The researchers reviewed endometrial samples taken from 107 women aged 20 to 35 years who had been diagnosed with either chronic endometritis or abnormal bleeding with otherwise normal endometrial linings that were either proliferative, secretory, shedding, or anovulatory.

The samples were stained for CD138 as well as tryptase, an enzyme that detects mast cells, which may resemble plasma cells and lead to false diagnoses of chronic endometritis. Two separate pathologists who were blinded to the original diagnosis reviewed the slides.

Of the 28 cases of chronic endometritis, just 18 samples were positive for CD138 and negative for tryptase, indicating an accurate diagnosis. However, Dr. Fuentes said, 10 samples were CD138-negative but tryptase-positive, indicating that mast cells had "fooled" pathologists into returning a 35% false-positive rate.

Similarly, 32 (40%) of the 79 "benign" samples were determined to be false-negatives, with positive results from the CD138 immunostain and negative results from tryptase.

The high rate of false-negatives could leave patients with unexplained excessive bleeding, leading to a hysterectomy that could be unwarranted, Dr. Fuentes noted. Eight percent of her samples were from hysterectomies. The use of the immunostain could improve the accuracy of diagnoses, she added.

"Those false-negatives should have been picked up," Dr. Fuentes told Medscape. "With this technique, we could help them, treat their endometritis with antibiotics, if clinically indicated. Doctors should consider using this stain to prevent women from undergoing unnecessary hysterectomies."

Another benefit to the immunostain is the time-saving aspect. The pathologists spent an average of three minutes inspecting the traditional hematoxylin and eosin slides compared with 15 seconds reviewing the immunostained slides. The total time spent analyzing the samples dropped from 5.35 hours to 53.6 minutes using the immunostain, or a 30-fold reduction. "It's a time benefit to the pathologist," Dr. Fuentes said.

While immunohistochemistry is more costly, Dr. Fuentes pointed out, the technique could reduce lab technician time searching for plasma cells, as well as prevent the cost of unnecessary surgery for a treatable condition.

The study did not receive any commercial support. The authors have disclosed no relevant financial relationships.

ASCP 2005 Annual Meeting: Abstract 72. Presented Oct. 9, 2005.

Reviewed by Gary D. Vogin, MD

    



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