免疫组化在肺小活检中对鳞状细胞癌和腺癌的鉴别诊断意义  

The role of a panel of immunohistochemical markers in differential diagnosis between primary lung squamous cell carcinoma and adenocarcinoma in biopsies

作　　者：张爱丽[1] 孙宇[2] 徐少艳[3] 贺红梅 曹登峰[2] 

机构地区：[1]天津港口医院病理科,天津300456 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所病理科,北京100142 [3]临淄区人民医院病理科,山东淄博255400 [4]秦皇岛市妇幼保健院病理科,河北秦皇岛066001

出　　处：《诊断病理学杂志》2016年第1期70-73,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨一组免疫组化标记物(p63、CK5/6、CK7、napsin A和TTF-1)在肺小活检中对鳞状细胞癌和腺癌的诊断与鉴别诊断意义。方法收集北京大学肿瘤医院83例肺原发性鳞状细胞癌和95例肺原发性腺癌的活检标本,应用免疫组化SP法检测p63、CK5/6、CK7、napsin A和TTF-1的表达。结果 p63和CK5/6在鳞状细胞癌中的阳性率分别为100%(83/83)和96%(80/83),特异性分别为80%和94%;CK7、napsin A和TTF-1在腺癌中的阳性率分别是94%(89/95)、71%(67/95)和87%(83/95),特异性分别是77%、100%和100%。结论对于肺鳞状细胞癌,p63的敏感性高于CK5/6,但p63的特异性差,在一部分腺癌中也有表达;对于肺腺癌,napsin A和TTF-1的特异性相同,但TTF-1的敏感性更高,尤其对于低分化腺癌,TTF-1是更好的免疫组化标记物;另外,CK7(+)更多见于腺癌,但是部分鳞状细胞癌也可以CK7(+)。因此,在非小细胞肺癌的小活检标本中,仅依靠形态学无法做出明确诊断时,鉴于没有任何一种标记物的敏感性和特异性均达到100%,故联合应用p63、CK5/6、CK7、napsin A和TTF-1能够提高敏感性和特异性。Objetive To investigate the role of a panel of immunohistochemical markers including p63, cytokeratin 5/6 （CK5/6）, CK7, napsin A and thyroid transcription factor 1 （TTF-1） in differential diagnosis between primary lung squamous cell carcinoma and adenocarcinoma in small biopsies. Methods Immunohistochemical markers of p63, CK5/ 6, CK7, napsin A and TTF-1 were examined in 83 primary lung squamous cell carcinomas and 95 adenocarcinomas by S-P immunohistochemical method. Results The positive rate of p63 and CK5/6 in squamous cell carcinomas was 100% （83/83） and 96% （80/83） , respectively, and their specificity was 80% and 94%, respectively. The positive rate of CK7, napsin A and TTF-1 in adenocarcinomas was 94% （ 89/95 ）, 71% （67/95） and 87% （ 83/95 ）, respectively, and their specificity was 77%, 100% and 100%, respectively. Conclusion P63 is more sensitive than CK5/6 for squamous cell carcinomas, but it is less specific than CK5/6. Napsin A and TTF-1 show similar specificity for adenocarcinomas, but TTF-1 is more sensitive than Napsin A especially in poorly differentiated adcnocarcinomas. In addition, CK7 staining is seen most frequently in adenocarcinomas but almost 40% squamous cell carcinomas also show positive CK7 staining. Therefore immunohistochemical staining is useful for differentiating lung squamous cell carcinoma from adenocarcinoma in biopsies. However, given that no single marker is absolutely sensitive and specific, an immunohistochemical panel consisting of p63, CK5/6, CK7, napsin A and TTF-1 should be performed.

关 键 词：免疫组化 小活检 肺 鳞状细胞癌 腺癌 

分 类 号：R734.2[医药卫生—肿瘤]