ER、VIM、CEA和p16四联检测在宫颈原发腺癌和子宫内膜癌诊断和鉴别中的应用  

Value of ER, VIM, CEA and p16 detection in the diagnosis and differential diagnosis of primary endocervical and endometrial adenocarcinomas

作　　者：胡维维[1] 陶金华[1] 李广民[1] 许欣[1] 杨秀媚[1] 

机构地区：[1]佛山市第一人民医院病理科,广东佛山528000

出　　处：《南方医科大学学报》2010年第3期526-528,531,共4页Journal of Southern Medical University

基　　金：佛山市科技攻关项目(200908064)

摘　　要：目的探讨ER、VIM、CEA和p16四联检测在宫颈原发腺癌和子宫内膜腺癌诊断和鉴别诊断中的应用价值。方法采用免疫组化EnVison法染色,观察ER、VIM、CEA和p16蛋白在31例宫颈原发腺癌和30例子宫内膜腺癌组织中的表达情况,比较四联检测和三联检测(ER、VIM和CEA)诊断宫颈原发腺癌和子宫内膜腺癌的特异性、敏感性、阳性预告值、阴性预告值和准确度。结果ER、VIM、CEA和p16在宫颈原发腺癌中的阳性表达率分别为35.5%、19.4%、77.4%和67.7%,在子宫内膜腺癌中则分别为70%、73.3%、40%和13.3%,差异均有统计学意义。四联检测对于诊断宫颈原发腺癌的特异性、敏感性、阳性预告值和准确度要高于三联检测-分别为96.3%(90.2%),65.1%(57.6%),94.9%(89.4%)和85.8%(80.6%),对于诊断子宫内膜腺癌的阴性预告值和准确度要高于三联检测-分别为58.7%(51.9%)和75.4%(68.6%),其他指标则基本相当。结论在传统三联检测中加入p16对于提高宫颈原发腺癌和子宫内膜腺癌的诊断和鉴别诊断准确有重要临床意义,尽管对于诊断敏感性的提高不够显著。Objective To evaluate the value of the detection of a 4-marker （ER, VIM, CEA and p16） panel in the differential diagnosis of primary endocervical and endometrial adenocarcinomas. Methods Immunohistochemical EnVison method was used to detect the expressions of ER, VIM, CEA and p16 in paraffin-embedded tissues from 31 cases of primary endocervical adenocarcinomas and 30 cases of endometrial adenocarcinomas. The specificity, sensitivity, predictive value and accuracy were compared between the 4-marker and 3-marker （ER, VIM and CEA） panels. Results The positivity rates of ER, VIM, CEA and p16 in endocervical adenocarcinomas were 35.5%, 19.4%, 77.4% and 67.7%, respectively; those in endometrial adenocarcinomas were 70%, 73.3%, 40% and 13.3%, respectively, showing significant frequency differences （P0.05） between primary endocervical and endometrial adenocarcinomas. The specificity, sensitivity, positive predictive value and accuracy of the 4-marker panel in endocervical adenocarcinomas were significantly higher than those of the 3-marker panel （96.3% vs 90.2%, 65.1% vs 57.6%, 94.9% vs 89.4%, and 85.8% vs 80.6%, respectively）. These values were almost similar for both panels in endometrial carcinoma except for better negative predictive value and accuracy value with the 4-marker panel （58.7% vs 51.9% and 75.4% vs 68.6%, respectively）. Conclusion Adding the p16 marker to the traditional 3-marker panel may have significant clinical importance in the differential diagnosis of primary endocervical and endometrial adenocarcinomas to improve the diagnostic accuracy, although there is only a slight increase in the diagnostic sensitivity.

关 键 词：宫颈原发腺癌 子宫内膜腺癌 ER VIM CEA P16 鉴别诊断 

分 类 号：R737.33[医药卫生—肿瘤]