快速免疫组化在前列腺穿刺活检组织冰冻病理诊断中应用的初步经验  

Preliminary analysis of the application of rapid immunohistochemistry in frozen pathological diagnosis of prostate biopsy tissues

作　　者：熊帅涛 王淼 刘龙腾[2] 吕政通 侯惠民[1] 陈佳 丁鑫 王悦 张伟[2] 刘明[1] Xiong Shuaitao;Wang Miao;Liu Longteng;Lyu Zhengtong;Hou Huimin;Chen Jia;Ding Xin;Wang Yue;Zhang Wei;Liu Ming(Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;University Fifth School of Clinical Medicine,Beijing 100730,China)

机构地区：[1]北京医院泌尿外科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院病理科、国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [3]北京大学第五临床医学院,北京100730

出　　处：《中华泌尿外科杂志》2024年第5期379-385,共7页Chinese Journal of Urology

基　　金：中央高水平医院临床科研业务费(BJ-2022-167);中央高水平医院临床科研业务费资助(BJ-2022-115)。

摘　　要：目的探讨在前列腺穿刺活检组织中应用CK5/6抗体快速免疫组化辅助冰冻病理诊断的准确性与可行性。方法回顾性分析2022年10月至2023年4月北京医院41例前列腺穿刺冰冻组织行CK5/6抗体快速免疫组化患者的资料。患者中位年龄76(69,79)岁,前列腺特异性抗原12.37(7.07,26.17)ng/ml。靶病灶的前列腺影像报告与数据系统(PI-RADS)评分均≥3分;其中3分9处(21.95%),4分15处(36.59%),5分17处(41.46%)。MRI检查病灶中位长径1.40(1.09,2.20)cm。病灶位于移行带14处(34.14%),外周带23处(56.10%),同时累及外周带和移行带病灶4处(9.76%)。采用经会阴认知融合靶向联合系统穿刺活检,术中于靶区和非靶区各额外取1针组织进行冰冻病理切片,并行HE染色和CK5/6抗体快速免疫组化染色,冰冻剩余组织行常规切片HE染色和CK5/6抗体常规免疫组化染色。记录冰冻病理和冰冻剩余组织常规切片的HE染色和免疫组化染色结果、国际泌尿病理学会(ISUP)分级分组,以及靶向联合系统穿刺的实际诊断结果等数据。以同一针穿刺组织的常规免疫组化结果为金标准,分析快速免疫组化冰冻病理诊断前列腺癌的敏感性和阳性预测值,及其病理分级分组的准确性。结果在41例患者中,靶区组织冰冻切片HE染色诊断前列腺癌35例,阳性率85.37%(35/41),其中ISUP分级分组1组17例(48.57%),2组8例(22.86%),3组4例(11.43%),4~5组6例(17.14%);同一针靶区冰冻剩余组织切片HE染色诊断前列腺癌35例,阳性率85.37%(35/41),其中ISUP分级分组1组16例(45.71%),2组9例(25.72%),3组4例(11.43%),4~5组6例(17.14%)。靶区组织快速免疫组化结果CK5/6表达阴性35例,阳性6例;常规免疫组化结果CK5/6阴性35例,阳性6例。非靶区组织快速免疫组化结果CK5/6表达阴性12例,阳性29例;常规免疫组化结果CK5/6阴性12例,阳性29例。靶区快速免疫组化诊断前列腺癌的35例与常规免疫组化诊断结果完全吻合,假阳性率为0Objective To investigate the accuracy and feasibility of applying rapid immunohistochemistry(IHC)with CK5/6 antibodies in prostate biopsy tissues to assist frozen pathology diagnosis.Methods The data of 41 patients who underwent prostate puncture and frozen tissue rapid IHC with CK5/6 antibody in Beijing Hospital from October 2022 to April 2023 were retrospectively analyzed.The median age of the patients was 76(69,79)years old,and the median PSA value was 12.37(7.07,26.17)ng/ml.The Prostate Imaging Reporting and Data System(PI-RADS)scores of the target lesions were all≥3.The PI-RADS score of 9 patients(21.95%)was 3,15(36.59%)was 4,and 17(41.46%)was 5.The median diameter of the lesions in the MRI examination was 1.40(1.09,2.20)cm.Fourteen lesions(34.14%)were located in the migratory zone,23(56.10%)were located in the peripheral zone,and 4(9.76%)involved both peripheral and migratory zone lesions.Transperineal cognitive fusion targeted combined systematic biopsy was used,and intraoperatively,1 additional needle was taken from each of the target and non-target areas for frozen pathology section,and hematoxylin eosin(HE)staining and rapid IHC staining with CK5/6 antibody was performed,then the frozen remaining tissue was HE staining and CK5/6 IHC staining.Data such as HE and rapid IHC results of frozen pathology sections and HE and IHC results of routine sections of the frozen remaining tissues,International Society of Urological Pathology(ISUP)grading groupings(CG),and actual diagnostic results of targeted combined systematic puncture were recorded.Using the routine IHC results of the same needle tissue as the gold standard,the sensitivity and positive predictive value of applying rapid IHC frozen pathology to diagnose prostate cancer and the accuracy of its pathological GG were analyzed.Results Among the 41 patients,a total of 35 cases were diagnosed with prostate cancer(PCa)by HE staining in frozen section of target tissue,with a positivity rate of 85.37%(35/41).Among these,there were 17 cases(48.57%)in ISUP GG

关 键 词：前列腺肿瘤 癌 前列腺穿刺活检 冰冻病理 快速免疫组化 

分 类 号：R737.25[医药卫生—肿瘤]