JP5962890B2 - Identification tool for cytodiagnosis, cytodiagnosis method using this identification tool, and cytodiagnosis kit - Google Patents

Description

  The present invention relates to an identification tool used when performing cytodiagnosis of a pathological tissue, a cytodiagnosis method using the identification tool, and a cytodiagnosis kit.

  Conventionally, in a disease in which tissue abnormality such as cancer occurs, cytodiagnosis in which a part of the tissue is taken out and observed with a microscope or the like has been performed.

  In particular, recently, the advanced functions of endoscopes enable the collection of necessary cells during examinations using endoscopes, which can greatly reduce the invasion of patients. .

  Specifically, for example, when a precise examination of the pancreas is to be performed, laparotomy has been required in spite of the examination in the past, but nowadays, an laparotomy is performed by using an ultrasonic endoscope. Inspection is possible without That is, the pancreas is located on the back side of the stomach, and the tip of an ultrasonic endoscope sent into the stomach from the mouth or nose is pressed against the stomach wall, and an abnormality is detected by performing an ultrasound examination of the pancreas. It can be detected.

  If abnormalities are observed, the puncture needle protrudes from the tip of the ultrasound endoscope, the abnormal part of the pancreas is punctured through the stomach wall, and the tissue piece is aspirated by applying negative pressure inside the puncture needle. ing.

  The tissue piece sucked into the puncture needle is fixed by taking out the puncture needle itself from the ultrasonic endoscope and discharging it into a container containing formalin, and performing a histopathological examination. In this case, the specimen fixed with formalin is usually in the form of a thread earthworm.

  When a specimen fixed with formalin is subjected to a histological examination, as shown schematically in FIG. 6, since the lesion area Y1 in which a lesion part effective for diagnosis exists is scattered in the specimen X, the specimen This is done by slicing X and observing the sliced surface. In FIG. 6, Y2 is a blood component region, and Y3 is a region composed of stromal cell components including vascular tissue and necrotic substances.

  When the specimen X is sliced, the portion including the lesion area Y1 is cut at the exposed portion such as the sliced surface a, but the specimen X itself is extremely small. It is impossible to slice while recognizing the position of the lesion, and the lesion area Y1 may not always be exposed on the sliced surface, such as the sliced surface b or the sliced surface c.

  When the lesion area Y1 is not exposed on the sliced surface such as the sliced surface b or the sliced surface c, it is sufficient that the lesion area Y1 does not exist in the specimen X, but it may happen that the lesion area Y1 is outside the lesion area Y1. Therefore, it is necessary to increase the accuracy of diagnosis by observing more sliced surfaces or increasing the number of samples X to be collected, which not only requires a lot of diagnosis time but also increases the diagnosis cost itself. It was supposed to be.

  Therefore, in recent years, rapid cytodiagnosis has been performed. In rapid cytodiagnosis, a sample collected with a puncture needle is discharged to a watch glass, a dish, etc., the entire discharged sample is observed, and the properties of the sample are judged from the color tone, and a lesion is present. The affected area is identified. Then, a part of the specified lesion area is sampled, smeared on a slide glass, stained, and immediately examined by microscopic examination.

  In such rapid cytodiagnosis, the entire specimen smeared on the slide glass can be microscopically examined, so that the diagnostic accuracy can be improved.

  In preparation of a specimen for cytodiagnosis, a method of preparing a specimen so that DNA quantification can be performed on a specimen smeared on a slide glass has also been proposed (see, for example, Patent Document 1).

Japanese Patent Application Laid-Open No. 07-027682

  As described above, in rapid cytodiagnosis, a lesion area where a lesion is considered to be present is specified based on the color tone from a specimen discharged to a watch glass or a dish, but there is always a clear color difference. However, there are many cases where it is somewhat unclear, and there is a problem that sampling errors are likely to occur.

  The number of punctures with the puncture needle tends to increase in consideration of the occurrence of this sampling error in advance, and the increase in the number of punctures is not only a problem that the invasiveness to the patient increases, but also the number of disposable puncture needles used There has been a problem of increasing costs due to the increase.

  By the way, the identification of the color tone of the sample discharged to the watch glass or the petri dish is only performed by placing the watch glass or the petri dish on which the sample is discharged on black paper or white paper. Research and development has been conducted for the purpose of eliminating the occurrence of sampling errors by more accurately identifying the color tone of the specimen, and the present invention has been achieved.

  The present invention relates to a box-shaped housing in which a placing portion on which a watch glass is placed is provided on a top plate, and a background attached to a bottom plate of the housing that is below the watch glass placed on the placing portion. An identification tool for cytodiagnosis used to identify the properties of a tissue piece in a specimen discharged into a watch glass with the background body as a background, and produces a light and dark gradation on the surface of the background body It is used as an identification tool for cytodiagnosis.

In particular, the identification tool for cytodiagnosis of the present invention is also characterized by the following points.
(1) An illuminating device that irradiates light toward the background body is provided inside the housing, and the illuminating device has an annular shape along the edge shape of the opening formed in the top plate as a mounting portion. When illuminating the background body with a lighting device, the portion below the center of the opening is illuminated darker than the surrounding area, creating a light and dark gradation on the surface of the background body. Being.
(2) The lighting fixture is a light emitting diode, and the background is a sheet-like black sponge.
(3) A cushioning material is detachably provided along the opening on the placing portion, and the watch glass can be stably placed via the cushioning material.

  Further, in the cytodiagnosis method of the present invention, in the cytodiagnosis method in which the tissue piece collected by the puncture needle is discharged to the watch glass placed on the placement part of the above-described cytodiagnosis identification tool, A hemolytic agent is applied to the tissue piece discharged in the step.

  The cytodiagnosis kit of the present invention comprises the above-described cytodiagnosis identification tool, a magnifying glass attached to a stand that can be fixed at a predetermined distance from the identification tool, and a hemolytic agent. Is.

  According to the present invention, it is possible to reliably identify the color tone of the specimen discharged to the watch glass by using the cytodiagnosis discriminating tool in which a light and dark gradation is generated on the surface of the background body. Occurrence can be eliminated.

  Therefore, the number of punctures can be reduced to the minimum necessary, and the invasion to the patient can be reduced, and the cost can be reduced by reducing the number of puncture needles used. Can be reduced.

It is a perspective view of the identification tool for cytodiagnosis concerning the present invention. It is an exploded view of the identification tool for cytology according to the present invention. It is a principal part longitudinal cross-sectional view of the lower housing | casing with which the illuminating device was mounted | worn. It is a top view of the identification tool for cytodiagnosis concerning the present invention. It is explanatory drawing of the cytodiagnosis kit which concerns on this invention. It is explanatory drawing of the thin slice performed with respect to a sample.

  In the present invention, it is possible to reliably identify a lesion contained in a specimen collected by a puncture needle or the like, and to reliably collect a sample for cytodiagnosis, a cytodiagnosis identification tool, and a cytodiagnosis method, And a cytodiagnosis kit.

  As shown in FIG. 1 and FIG. 2, the identification tool A for cytodiagnosis includes a box-shaped housing 20 in which a placing portion 21 on which a watch glass 10 is placed is provided on a top plate 20u-5. As shown in FIGS. 2 and 3, a background body 40 is provided that is attached to the bottom plate 20 d-5 of the housing 20 below the watch glass 10 placed on the placement unit 21.

  In particular, in the identification tool A of the present embodiment, as shown in FIG. 2, the casing 20 is composed of an upper casing 20u and a lower casing 20d.

  The upper housing 20u includes an upper first side wall 20u-1, an upper second side wall 20u-2, an upper third side wall (not shown), and an upper portion on four sides of a substantially square top plate 20u-5. It has a box shape having a bottom opening provided with a fourth side wall 20u-4.

  The lower housing 20d has a lower first side wall 20d-1, a lower second side wall 20d-2, a lower third side wall 20d-3, and a lower fourth side wall on four sides of a substantially square bottom plate 20d-5. It has a box shape having an upper opening provided with 20d-4.

  The upper casing 20u and the lower casing 20d are integrated by fitting the upper first to fourth side walls 20u-1 to 4 on the outer peripheral surfaces of the lower first to fourth side walls 20d-1 to 4 The housing 20 is configured.

  In the present embodiment, female screw portions 22 in which helicates are embedded are provided at predetermined positions on the lower second side wall 20d-2 and the lower fourth side wall 20d-4, respectively, and the upper second side wall overlapped with the lower second side wall 20d-2. A through hole 23 is provided at a predetermined position of the upper fourth side wall 20u-4 superimposed on 20u-2 and the lower fourth side wall 20d-4, and a fixing screw 24 is attached to the female screw part 22 through the through hole 23. Thus, the upper casing 20u and the lower casing 20d are firmly united.

  In the upper housing 20u, an opening 21a as a placement portion 21 is provided in the central portion of the substantially square top plate 20u-5. The opening 21a has a circular shape in the present embodiment in order to make it easier to place the circular watch glass 10. However, the opening 21a is not limited to a circular shape, and may be a polygonal shape or an elliptical shape.

  A groove 21c for fitting the cushioning material 21b is provided on the top surface of the top plate 20u-5 at the outer peripheral portion of the opening 21a. The groove 21c has a circular shape along the opening, and a cushioning material 21b made of silicon rubber having a predetermined length of prismatic shape is detachably fitted into the groove 21c.

  The mounting portion 21 includes the opening 21a, the buffer material 21b, and the groove 21c. The watch glass 10 can be stably mounted via the buffer material 21b. Therefore, the opening diameter of the opening 21a is about 90% of the diameter of the watch glass 10.

  The lower housing 20d is provided with a cylindrical guide wall 25 that is partially cut out on a substantially square bottom plate 20d-5. The guide wall 25 is positioned at the center of the opening 21a provided in the top plate 20u-5 of the upper housing 20u on the extension line of the axial center.

  A connecting wall 26 is installed between the end of the notched guide wall 25 and the lower first side wall 20d-1, and the guide wall 25 is connected to the lower first side wall 20d- through the connecting wall 26. By integrating with 1, the strength of the guide wall 25 is increased.

  The guide wall 25 can be inserted with a lighting device 30 having a circumferential outer peripheral surface to be described later. In particular, the inner diameter of the guide wall 25 is such that the inner peripheral surface of the guide wall 25 abuts on the outer peripheral surface of the lighting device 30 inserted into the guide wall 25 and the horizontal movement of the lighting device 30 inserted into the guide wall 25 Are regulated by the guide wall 25.

  Further, in the guide wall 25 of the present embodiment, a step is formed by bulging from the bottom plate 20d-5 to a predetermined height in the center direction so as to be thick, and the step formed by this step. As shown in FIG. 3, the surface is a support surface 27 with which the lower end surface of the illumination device 30 abuts. FIG. 3 is a longitudinal sectional view of a main part of the lower housing 20d to which the lighting device 30 is attached.

  The support surface 27 may be formed not only when the guide wall 25 is formed thick, but also by projecting a flange toward the center of the guide wall 25.

  In the present embodiment, the support surface 27 is provided so as to extend to the lower first side wall 20d-1, and the control circuit unit 31 of the lighting device 30 described later can also be supported.

  As shown in FIG. 2, the illumination device 30 uses annular illumination that is used as a light source of a stereomicroscope.

  In the past, annular illumination using an annular fluorescent tube has been frequently used as a light source for a stereomicroscope. Recently, however, as shown in FIG. 3, an illuminator L composed of light-emitting diodes is annularly arranged. In this embodiment, annular illumination using white light emitting diodes is used. By using a light-emitting diode as a light source, there is no generation of heat, and the possibility that the specimen is heated and dried with illumination can be eliminated.

  The opening 21a of the mounting portion 21 is smaller than the opening diameter size of the hollow portion in the annular lighting portion of the lighting device 30, and the lighting portion can be seen through the watch glass 10 placed on the mounting portion 21. In this way, the illumination device 30 is prevented from entering the visual field and interfering with the tissue tone color tone identification operation described later.

  In the present embodiment, the light source of the stereomicroscope is used as the illumination device 30, but a dedicated illumination device may be used, and illumination is performed in a ring shape along the edge shape of the opening 21a formed in the top plate 20u-5. It is desirable to place tools.

  Further, in the illumination device 30 of the present embodiment, a control circuit unit 31 is provided by bulging in a radial direction in a part of the annular illumination unit, and an on / off switch 32 is provided in the control circuit unit 31. The lighting can be switched on and off. The control circuit unit 31 is provided with a light amount adjustment dial 33 so that the light amount can be adjusted.

  Furthermore, in this embodiment, the power supply adapter 35 is connected to the control circuit unit 31 via the cable 34 so that power can be supplied from an outlet. However, power may be supplied from an appropriate battery or battery.

  As shown in FIG. 3, the illumination device 30 is inserted into the guide wall 25 of the lower housing 20d and placed on the support surface 27, and irradiates light toward the bottom plate 20d-5 of the lower housing 20d. I am going to do that. Reference numeral 28 in FIG. 2 denotes a lower notch groove provided for pulling out the cable 33 of the lighting device 30 to the outside of the housing 20.

  Then, by fitting the upper housing 20u to the lower housing 20d in which the lighting device 30 is inserted, the lighting device 30 is also sandwiched between the upper housing 20u and the lower housing 20d in the vertical direction. It is supposed to be fixed more securely inside. Reference numeral 29 in FIG. 2 denotes an upper notch groove provided for pulling out the cable 33 of the lighting device 30 to the outside of the housing 20.

  Before the lighting device 30 is inserted into the guide wall 25 of the lower housing 20d, the background body 40 is inserted inside the guide wall 25 as shown in FIGS. The background body 40 is attached to the bottom plate 20d-5.

  The background body 40 is a sheet-like polyurethane sponge and has a circular shape matching the inner diameter of the guide wall 25. In particular, the background body 40 is preferably black.

  As shown in FIG. 3, the illumination device 30 irradiates light toward the background body 40, and the background body 40 suppresses the irregular reflection of the light emitted from the illumination device 30, while the illumination device 30 It is supposed to turn into a white screen illuminated by 30.

  As described above, since the illumination device 30 has an annular illumination part, the illuminance at the annular central part is smaller than the illuminance directly below the light emitting diode, and is formed on the top plate 20u-5. As shown in FIG. 4, a portion of the central portion of the opening 21a that is vertically below is illuminated darker than its surroundings, resulting in a light and dark gradation on the surface of the background body 40 illuminated by the lighting device 30. It is supposed to let you. FIG. 4 shows a state in which the identification tool A for cytodiagnosis with the illumination device 30 turned on in a state where the watch glass 10 is not placed on the placement unit 21 is viewed from above.

  By adjusting the distance between the illuminating device 30 and the background body 40, the illuminance at the center of the ring is made the same level as the illuminance directly under the light emitting diode, and the surface of the background body 40 is made to have a uniform white state Although it is possible, in the present invention, a light and dark gradation is generated on the surface of the background body 40.

  By creating a gradation of light and dark on the surface of the background body 40, the color tone of the specimen discharged to the watch glass 10 can be identified as described later by using the lightness and darkness of the background. Can be increased.

  Further, in the discrimination tool A for cytodiagnosis of the present invention, unlike the case where the background when the color tone of the specimen is identified is white paper or black paper, the background body 40 is also irradiated with light by indirect light. Therefore, it is considered that the color tone of the specimen can be easily identified, and since the fine adjustment of the light intensity can be performed using gradation, it is considered that the identification accuracy can be improved.

  In the present embodiment, the distance from the background body 40 to the lighting device 30 is adjusted in advance so that the most suitable light and dark gradation can be generated by the used lighting device 30, but if necessary, the background The distance from the body 40 to the lighting device 30 can be adjusted, and the gradation of light and darkness generated on the surface of the background body 40 can be adjusted.

  In the above-described identification tool A for cytodiagnosis of the present embodiment, the above-described configuration is obtained by diverting the light source of the stereomicroscope. It can also be used as a tool.

  Further, the above-described identification tool A for cytology can be stored in the storage case B as shown in FIG. In this storage case B, together with the identification tool A, a magnifying glass 52 attached to the storage case B via the stand 51, a hemolytic agent 53 and a staining solution 54 are stored to form a cytodiagnosis kit. Carrying around.

  Further, in the storage case B, tweezers 55 used when handling the specimen, a spare watch glass (not shown), a sample bottle (not shown), or the like may be stored.

  Since the magnifying glass 52 is attached to the storage case B via the stand 51, the magnifying glass 52 can be easily fixed at a predetermined distance from the watch glass 10 placed on the identification tool A for cytodiagnosis. Even when a specimen is collected using such a thin needle, the specimen can be identified by being magnified by the magnifier 52.

  Hereinafter, a cytodiagnosis method using the identification tool A and cytodiagnosis kit for cytodiagnosis of the present invention will be described. In the following, the case of ultrasonic endoscopy will be described. However, even in cytodiagnosis without using an ultrasonic endoscope, only the sample collection method is different. Are the same, and can be used, for example, for puncture aspiration cytology in the mammary gland, thyroid gland, lymph nodes, and the like. Incidentally, an ultrasonic endoscope is mainly used for examination of pancreatic tumor, gastrointestinal submucosal tumor, adrenal tumor, mediastinal tumor, liver tumor and the like, but is not limited thereto. For example, it can be used for cytodiagnosis of a specimen obtained by puncture and suction with an ultrasonic bronchoscope.

  First, an ultrasonic image of a lesion is drawn using an ultrasonic endoscope, and the necessity of sample collection is determined.

  When it is determined that sample collection is necessary, the puncture needle is protruded from the tip of the ultrasonic endoscope, the puncture needle is punctured into a portion that is considered to be a lesion, and the inside of the puncture needle is made negative pressure. Aspirate a piece.

  Thereafter, the negative pressure is released, the puncture needle is extracted from the ultrasonic endoscope, and the tissue piece in the puncture needle is discharged onto the watch glass.

  The watch glass from which the tissue piece has been discharged is placed on the placement portion 21 of the identification tool A for cytodiagnosis. When the magnifying glass 52 is required, the position of the magnifying glass 52 is adjusted in advance.

  The lighting device 30 is turned on, the background body 40 below the watch glass 10 is a white screen, and the indirect light reflected from the background body 40 is irradiated to the tissue pieces in the watch glass 10, so that the color tone of the tissue pieces Identify.

  At this time, if the collected tissue piece contains a lot of blood, an appropriate amount of hemolytic agent 53 is applied to the tissue piece. As the hemolytic agent 53, BD Site Rich (registered trademark) manufactured by Nippon Becton Dickinson Co., Ltd. is suitable.

  The color tone of the collected tissue piece is generally roughly divided into three patterns of transparent, white, and red, and the lesion tissue is often included in the transparent part. Therefore, by applying the hemolytic agent 53 to the tissue piece, the blood adhering to the transparent portion can be removed, and the lesion tissue can be easily identified.

  By confirming the presence or absence of the transparent part in the collected tissue piece, the validity of the specimen collection with the puncture needle can be judged, and only when the transparent part has not been collected, again the specimen with the puncture needle By performing sampling, the number of punctures can be minimized. By minimizing the number of punctures, the invasion to the patient can be suppressed, the number of puncture needles used can be suppressed, and medical costs can be suppressed.

  Note that the collected specimen does not necessarily contain solid matter, and may be a liquid-only specimen. However, even such a liquid specimen contains a lesioned tissue in a transparent portion. In many cases, it can be reliably identified by the identification tool A for cytodiagnosis of the present invention.

  In the collected tissue piece, all or part of the confirmed transparent portion is sampled, smeared on a slide glass, treated with an appropriate staining solution 54, and immediately examined for cytology. be able to.

  On the other hand, among the pieces of tissue remaining on the watch glass, the solid matter that can be picked with tweezers is placed in a formalin-containing sample bottle so that it can be used for histological examination. Other liquid matters are temporarily placed in a sample bottle with a dropper, Cell block.

  In particular, the created cell block can be used for additional searches in cytology such as special staining and chemical search for immune tissues. It can be used for specimens smeared on slide glass from the above-mentioned collected specimens or fixed with formalin. Since it can be used as a third sample other than the prepared sample, it can contribute to rapid diagnosis.

  In the identification tool A for cytodiagnosis according to the present invention, the watch glass 10 is used as described above. However, since the watch glass 10 has a depressed central portion, a tissue piece collected on the watch glass 10 with a puncture needle. When the liquid is discharged, the liquid material is likely to collect in the central part, the contact area with the air becomes small, and it is easy to suppress the drying and denaturation of the tissue piece. Can be made easy.

A Identification tool for cytology
10 watch glass
20 enclosure
20u upper housing
20u-5 Top plate
20d lower housing
20d-5 Bottom plate
21 Placement section
21a opening
21b cushioning material
21c groove
22 Female thread
23 Through hole
24 fixing screw
25 guide wall
26 Connecting wall
27 Support surface
28 Lower notch
29 Upper notch
30 Lighting equipment
31 Control circuit
32 ON / OFF switch
33 Light adjustment dial
34 Cable
35 Power adapter
40 background

Claims (6)

A box-shaped housing provided with a placing portion on the top plate on which the watch glass is placed;
A background body mounted on the bottom plate of the housing that is below the watch glass placed on the placement unit,
An identification tool for cytodiagnosis used to identify the properties of a tissue piece in a specimen discharged into the watch glass against the background body,
In the inside of the housing, while providing an illumination device that irradiates light toward the background body,
The illuminating device is an identification tool for cytology in which the illuminating device is arranged in an annular shape along the edge shape of the opening formed in the top plate as the mounting portion. Claims when shone before Symbol said background member in the illumination device, the vertical lower portion of the central portion of the opening, by illuminating darker than its surroundings, which causes a gradient of brightness on the surface of said background member Item 2. The identification tool for cytology according to Item 1.   The identification tool for cytodiagnosis according to claim 2, wherein the illuminating device is a light emitting diode, and the background is a sheet-like black sponge.   The cell according to claim 2 or 3, wherein a buffer material is detachably provided along the opening in the mounting portion, and the watch glass can be stably placed via the buffer material. Identification tool for diagnosis. In the method of cytodiagnosis performed by discharging a tissue piece collected with a puncture needle to a watch glass placed on the placement part of the identification tool for cytology according to any one of claims 1 to 4,
A cytodiagnosis method in which a hemolytic agent is applied to a tissue piece discharged onto the watch glass. The identification tool for cytology according to any one of claims 1 to 4,
A magnifying glass attached to a stand that can be fixed at a predetermined distance from the identification tool;
A cytodiagnosis kit comprising a hemolytic agent.

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