胸腔积液脱落细胞免疫组化染色对肿瘤来源鉴别诊断价值的探讨  

Exploration of the immunochemistry staining on the exfoliative cells in the pleural effusion in the differential diagnosis of tumor origins

作　　者：侯刚[1] 尹燕[1] 韩丹[1] 康大海[1] 王秋月[1] 康健[1] 

机构地区：[1]中国医科大学附属第一医院呼吸疾病研究所,辽宁沈阳110001

出　　处：《中华肿瘤防治杂志》2012年第21期1647-1650,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:评估波形蛋白(VIM)、神经特异度钙结合蛋白(CR)、间皮细胞(MC),细胞角蛋白7(CK7)和甲状腺转录因子-1(TTF-1)免疫组化染色在转移性肺腺癌和恶性间皮瘤鉴别诊断中的价值。方法:收集经病理学确诊的恶性胸腔积液患者82例,选取其中的胸膜转移性肺腺癌和恶性胸膜间皮瘤患者纳入分析。评估TTF-1、CK7、Vimentin、MC和Cal-retinin 5项指标对胸膜转移性肺腺癌和恶性胸膜间皮瘤的诊断灵敏度和特异度。结果:VIM(χ2=4.99,P=0.014)、CR(χ2=23.74,P=0.01)和MC(χ2=13.08,P=0.001)的表达在恶性胸膜间皮瘤的表达高于胸膜转移性肺腺癌。而TTF-1(χ2=21.67,P<0.01)和CK7(χ2=18.12,P<0.01)在胸膜转移性肺腺癌表达高于恶性胸膜间皮瘤。对于恶性间皮瘤的诊断,VIM的灵敏度为72.7%(8/11),特异度为64.4%(29/45);CR的灵敏度为90.9%(10/11),特异度为84.4%(38/45);MC的灵敏度为72.7%(8/11),特异度为82.2%(37/45)。对于胸膜转移性肺腺癌的诊断,CK7的灵敏度为95.6%(43/45),特异度为54.5%(6/11);TTF-1的灵敏度为82.2%(37/45),特异度为90.9%(10/11)。结论:胸腔积液脱落细胞的TTF-1、CK7、Vimentin、MC和Calretinin免疫组化染色对恶性胸膜间皮瘤和胸膜转移性肺腺癌的鉴别具有较高价值。OBJECTIVE： To evaluate the value of the immunochemistry staining of vimentin （VIM）, calretinin （CR）,mesothelial cell （MC）,cytokeratin7 （CK7） and thyroid transcription factor-1 （TTF-1） in the differential diagnosis of malignant pleural effusion caused by malignant pleural mesothelioma and metastatic pulmonary adenocarcinoma. METH- ODS：Consecutively collected 82 cases of malignant pleural effusions determined by pathological examination. Malignant pleural mesothelioma and metastatic pulmonary adenocarcinoma were enrolled analysis to evaluate the diagnosis sensitivity and specificity of VIM,CR, MC,CK7 and TTF-1 to diagnosis malignant pleural effusions. RESULTS： The expression of VIM （χ^2=4.99,P=0. 014） ,CR （χ^2=23.74,P=0.01） ,MC （χ^2=13.08,P：0. 001） in the malignant pleural mesothelioma was higher than those in the metastatic pulmonary adenocarcinoma. The expression of TTF-1 （χ^2=21.67,P〈0.01） and CK7 （χ^2= 18.12,P〈0. 001） in metastatic pulmonary adenocarcinoma was higher than those in the malignant pleural mesothelioma. The expressions of VIM, MC and CR of malignant pleural mesothelioma showed higher performance than that of metastatic pulmonary adenocarcinoma （P〈0.05）. The expression of CK7 and TTF-1 of metastatic pulmonary adenocarcinoma also had higher performance than that of malignant pleural mesothelioma （P〈0.01）. For the malignant pleural effusion, the diagnosis sensitivity and specificity of VIM were 72.7 % （8/11） and 64. 4 % （29/45）, those of CR were 90.9%（10/11） and 84.4%（38/45） ,those of MC were 72.7%（8/11） and 82.2%（37/45）. For the metastatic pulmonary adenocarcinoma,the diagnosis sensitivity and specificity of CK7 were 95.6% （43/45） and 54. 5% （6/11）while those of TTF-1 were 82.2% （37/45）and 90. 9% （10/11）. CONCLUSION： The immunochemistry staining of VIM, CR, MC, CK7 and TTF-1 of exfoliated cells of pleural effusion has better performance on the differential diagnosis of malignant pleural meso

关 键 词：胸膜肿瘤 间皮瘤 肺肿瘤 波形蛋白 钙结合蛋白质类 角蛋白 

分 类 号：R734.3[医药卫生—肿瘤]