免疫组化对恶性胸膜上皮型间皮瘤与肺腺癌鉴别诊断价值的探讨  

Immunohistochemical features of malignant pleural epithelial mesothelioma and differential diagnosis with lung adenocarcinoma

作　　者：张继贤[1,2] 赵莺[1,2] 卢韶华[3] 

机构地区：[1]宁波大学医学院附属阳明医院 [2]余姚市人民医院呼吸科,浙江余姚315400 [3]复旦大学附属中山医院病理科,上海200032

出　　处：《中华肿瘤防治杂志》2013年第3期221-225,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：余姚市科技局计划项目(2008Y06)

摘　　要：目的:探讨免疫组化对恶性胸膜上皮型间皮瘤与肺腺癌鉴别诊断的价值。方法:用免疫组化SP法检测27例胸膜上皮型恶性间皮瘤和30例肺腺癌组织中,Calretinin、WT1、D2-40、CK5/6、CEA、MOC-31和TTF-1的表达情况,并应用受试者工作曲线(ROC)对检查结果分析,选择更合适的一组抗体用于恶性间皮瘤与肺腺癌的鉴别诊断。结果:Calretinin、D2-40、WT-1、CK5/6、CEA、MOC-31和TTF-1在恶性间皮瘤组织中的阳性表达率分别为92.5%(25/27)、92.5%(25/27)、96.3%(26/27)、77.8%(21/27)、11.1%(3/27)、0(0/27)和37.0%(10/27);在腺癌组织中的阳性率分别为13.3%(4/30)、6.7%(2/30)、10.0%(3/30)、26.7%(8/30)、90.0%(27/30)、83.3%(25/30)和96.7%(29/30)。间皮瘤阳性标志Calretinin、D2-40、WT1和CK5/6的ROC曲线下面积(AUC)值分别为0.896、0.930、0.931和0.756,腺癌标志CEA、TTF-1和MOC-31的AUC值分别为0.894、0.917和0.798。结论:免疫组化是鉴别恶性间皮瘤与腺癌最好的方法,Calretinin、WT1、D2-40、CEA和TFF-1是较为理想的标志,可作为恶性间皮瘤和腺癌鉴别诊断中的首选抗体。OBJECTIVE： To explore the role of immunohistochemical assay in distinguishing malignant epithelioial pleural mesothelioma from lung adenocarcinoma. METHODS： SP immunohistoehemical method was used to detected ex- pression of Calretinin, D2-40, WT1, CK5/6, CEA, TTF-1 and MOC-31 in 27 cases of malignant epithelioial pleural me- sothelimas and 30 cases of lung adenocarcinomas. Receiver operating characteristic curve（ROC） analysis was used to iden- tify a selected appropriate panel antibodies for diffrention of malignant epithelioid mesothelioma and lung adenocarcinama. RESULTS： The results of positive expressions in malignant epithelial pleural mesothelioma were as follows, 92. 5% （25/27） for Calretinin,92.5%（25/27） for D2-40,96.3%（26/27） for WT1,77.8%（21/27）for CK5/6,11.1%（3/27） for CEA,0（0/27） for TTF-1 and 37.0%（10/27） for MOC-31. The results of positive expression in lung adenocarcinoma were 13.3%（4/30） for Calretinin,6.70%（2/30） for D2-40,10.0%（3/30） for WT1,26.7%（8/30） for CK5/6,90.0%（27/30） for CEA, 83.3% （25/30） for TTF-1 and 96.7 % （29/30） for MOC-31. Among the mesothelioma positive markers, the val- ue of AUC in Calretinin,D2-40, WT1 and CK5/6 were 0. 896,0. 930,0. 931 and 0. 756. Among the carcinama markers, the value of AUC in CEA,TTF-1 and MOC-31 were 0. 894,0. 917 and 0. 798. CONCLUSIONS： Immunohistchemistry is the best method to distinguishing malignant mesothelioma from lung adenocarcinoma. Calretinin, D2-40, WT1, CEA and TTF-1 are ideal the markers in differentiating epithelioid mesothelioma from lung adenocarcinoma.

关 键 词：间皮瘤 胸膜肿瘤 肺肿瘤 诊断 鉴别 免疫组织化学 

分 类 号：R734.3[医药卫生—肿瘤]