Abstract: Objective To explore the value of combination of immunofluorescence cytochemical staining (ICS) and laser-scanning confocal microscopy (LSCM) in the diagnosis of meningeal carcinomatosis. Methods ICS and LSCM were used to detect the cellular distribution and quantity of epithelial membrane antigen (EMA) in cerebrospinal fluid (CSF) cells of patients with meningeal carcinomatosis (MC group) and controls (control group). Results The EMA was expressed with red fluorescence in the cytoplasm of meningeal carcinomatosis cells. The mean fluorescent intensity of cellular EMA in meningeal carcinomatosis cells of CSF in MC group (44.84 ± 13.05) was significantly higher than the cells of CSF in control group (3.98 ± 1.58; t = 43.954, P = 0.001). The positive rate of routine cerebrospinal fluid cytologic examination (May-Grunwal-Giemsa staining) and EMA immunofluorescence examination combined LSCM was 60% (12/20) and 90% (18/20), respectively, the difference was significant ( χ 2 = 4.800, P = 0.010). Conclusion The combination of immunofluorescence cytochemical staining and LSCM for the detection of EMA expression changes in cells of CSF is useful for the diagnosis and differential diagnosis of meningeal carcinomatosis.

Key words: Meningeal neoplasms, Cerebrospinal fluid, Neoplasm metastasis, CA-15-3 Antigen, Microscopy, confocal, Fluoroimmunoassay

摘要： 目的 探讨免疫荧光细胞化学染色与激光扫描共聚焦显微技术联合检测在脑膜癌病诊断中的价值。方法 采用免疫荧光细胞化学染色法，以小鼠抗人单克隆上皮膜抗原（EMA）标记脑膜癌细胞及对照组脑脊液细胞，激光扫描共聚焦显微技术获得脑膜癌细胞扫描图像并定量检测上皮膜抗原相对荧光强度。结果 上皮膜抗原主要表达于脑膜癌细胞的细胞质和细胞膜，着红色荧光，相对荧光强度为（44.84 ± 13.05），与对照组（3.98 ± 1.58）相比差异有统计学意义（t = 43.954，P = 0.001）。免疫荧光细胞化学染色联合激光扫描共聚焦显微技术对上皮膜抗原的检测阳性率为90%（18/20），高于常规MGG 染色法［60%（12/20）］，组间差异具有统计学意义（χ2 = 4.800，P = 0.010）。结论 免疫荧光细胞化学染色与激光扫描共聚焦显微技术联合检测脑脊液细胞上皮膜抗原表达变化，可为脑膜癌病的诊断、组织来源提供实验室依据。

关键词: 脑膜肿瘤, 脑脊髓液, 肿瘤转移, CA-15-3 抗原, 显微镜检查, 共焦, 荧光免疫测定