间变性淋巴瘤激酶阳性非小细胞肺癌患者的筛查及其临床病理特征  

Expression of anaplastic lymphoma kinase and its clinical significance in non-small cell lung cancer

作　　者：李桂梅[1] 侯宁[2] 曹晓卉[1] 杨志慧[1] 潘书梅[1] 

机构地区：[1]解放军八一医院病理科,南京210002 [2]江苏省肿瘤研究所病理科

出　　处：《中华病理学杂志》2014年第11期742-746,共5页Chinese Journal of Pathology

基　　金：全军临床高新技术重大项目

摘　　要：目的：探讨非小细胞肺癌中不同间变性淋巴瘤激酶（ ALK）检测方法的特点，分析ALK阳性与患者临床病理特征的关系。方法筛选2011年至2013年间经病理证实的非小细胞肺癌100例患者的经甲醛固定、石蜡包埋的组织作为研究对象，采用免疫组织化学和荧光原位杂交（ FISH）方法对ALK融合基因进行检测，并分析其相关的临床病理资料。结果100例患者中ALK免疫组织化学染色强度为3＋（12例）和0（78例）的患者与FISH检查结果一致，免疫组织化学2＋和1＋患者FISH检测阳性比例为6／7和2／3。免疫组织化学染色的敏感性和特异性分别为100％和98％。病理类型以肿瘤细胞异型性较小、黏液腺癌、实体型或腺泡型伴黏液分泌和／或含有印戒细胞的腺癌多见。结论 ALK阳性非小细胞肺癌具有一定的组织学特点，免疫组织化学标记可作为筛选ALK阳性患者的常规方法，对阳性患者进一步行FISH法确诊，正确指导临床治疗方案的选择。Objective To investigate the frequency of anaplastic lymphoma kinase （ ALK ） expression in non-small cell lung cancer （ NSCLC ） patients and its correlation with the clinicopathologic features.Methods ALK immunohistochemistry and ALK fluorescent in situ hybridization （ FISH ） were performed on formalin-fixed, paraffin-embedded tissue in 100 cases of NSCLCs between 2011 and 2013.Relevant clinicopathologic data were collected and correlated with ALK expression.Results All patients with immunohistochemical score of 3 （n=12） were FISH-positive and all patients with score of 0 （n=78） were FISH-negative.Among patients with immunohistochemical scores of 1 and 2, 2/3 and 6/7 were FISH-positive, respectively.The sensitivity and specificity of ALK immunohistochemistry with intensity score of 1 or more were 100% and 98%, respectively.Invasive mucinous adenocarcinoma , solid or acinar growth pattern, presence of mucous cells （ signet-ring cells or goblet cells ）, extracellular mucus and lack of significant nuclear pleomorphism characterized ALK-rearranged cancer.Conclusions ALK-rearranged cancers possess specific histological features.Immunohistochemistry can be used as a routine test for screening ALK-positive cases in advanced NSCLC , and FISH testing should be used to confirm ALK translocation for patients with tumors showing staining for ALK by immunohistochemistry.All of these can help physicians identify patients who may benefit from targeted therapy.

关 键 词：肺肿瘤 癌 非小细胞肺 免疫组织化学 原位杂交 荧光 

分 类 号：R734.2[医药卫生—肿瘤]