术中快速免疫组化特征用于鉴别诊断子宫平滑肌肉瘤的效能分析  

Efficacy analysis of intraoperative rapid immunohistochemical features in the differential diagnosis of uterine leiomyosarcoma

作　　者：牛群丽 罗莎 臧海兰 刘佳 付静 Niu Qunli;Luo Sha;Zang Hailan;Liu Jia;Fu Jing(Department of Pathology,The 980th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army,Shijiazhuang Hebei 050082;Department of Gynecology,Anxin County Hospital,Baoding Hebei 071600;Department of Obstetrics and Gynecology,Luancheng People's Hospital,Shijiazhuang Hebei 051430,P.R.China)

机构地区：[1]中国人民解放军联勤保障部队第九八〇医院病理科,河北石家庄050082 [2]河北安新县医院妇科,河北保定071600 [3]石家庄市栾城人民医院妇产科,河北石家庄051430

出　　处：《中国计划生育和妇产科》2025年第3期91-96,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：河北省中医药管理局科研计划项目(项目编号:2023344)。

摘　　要：目的 探讨术中快速免疫组化对子宫平滑肌肉瘤的鉴别诊断效能。方法 纳入2020年1月至2022年12月于中国人民解放军联勤保障部队第九八〇医院行手术治疗的子宫平滑肌瘤及子宫平滑肌肉瘤患者共120例,根据术后病理结果分为肉瘤组(n=48例)及非肉瘤组(n=72例)。比较两组患者一般临床资料及实验室指标,在术中留取病理组织行快速免疫组化及病理检查,比较两组常规快速病理及免疫组化结果,并分析术中快速免疫组化对子宫平滑肌肉瘤诊断的一致性。结果 肉瘤组患者Ki67、P53阳性比例显著高于非肉瘤组,而P16、ER及PR阳性患者比例显著低于非肉瘤组(P<0.05);多因素Logistic回归分析示上皮样特征、平均有丝分裂≥10/HPFs、P16阳性表达是子宫肉瘤的独立危险因素,而ER及PR阳性表达是其独立保护因素(P<0.05);列线图预测子宫肉瘤相关因素的C-index为0.969(95%CI:0.965-0.996);ROC曲线示,上皮样特征、平均有丝分裂≥10/HPFs,P16、ER及PR阳性表达指标构建的预测风险模型在诊断子宫肉瘤方面具有良好的预测价值(AUC=0.942),显著高于上皮样特征、平均有丝分裂≥10/HPFs,P16、ER及PR阳性表达单一指标预测(P<0.001),灵敏度85.4%,特异度91.7%。结论 P16、ER及PR等术中免疫组化检测可有效对子宫肉瘤进行预测,具有较高的诊断效能。Objective To explore the differential diagnostic efficacy of intraoperative rapid immunohistochemistry for uterine leiomyosarcoma.Methods A total of 120 patients with uterine leiomyoma and uterine leiomyosarcoma who underwent surgical treatment in the 980th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army from January 2020 to December 2022 were included.According to the postoperative pathological results,they were divided into the sarcoma group(n=48) and the non-sarcoma group(n=72).The general clinical data and laboratory indicators of the two groups of patients were compared,pathological tissues were collected during the operation for rapid immunohistochemistry and pathological examination.The results of routine rapid pathology and immunohistochemistry of the two groups of patients were compared,and the consistency of intraoperative rapid immunohistochemistry in the diagnosis of uterine leiomyosarcoma was analyzed.Results The proportion of patients with positive Ki67 and P53 in the sarcoma group was significantly higher than that in the non-sarcoma group,while the proportion of patients with positive P16,ER,and PR was significantly lower than that in the non-sarcoma group(P<0.05).Multivariate Logistic regression analysis showed that epithelioid features,an average mitotic count of ≥ 10/HPFs,and positive P16 expression were independent risk factors for uterine sarcoma,while positive ER and PR expressions were independent protective factors(P<0.05).The C-index of the nomogram for predicting factors related to uterine sarcoma was 0.969(95% CI:0.965-0.996).The ROC curve showed that the predictive risk model constructed by epithelioid features,an average mitotic count of ≥ 10/HPFs,and positive expressions of P16,ER,and PR had good predictive value in the diagnosis of uterine sarcoma(AUC=0.942),which was significantly higher than the prediction by single indicators of epithelioid features,an average mitotic count of ≥ 10/HPFs,and positive expressions of P16,ER,and PR(P<0.001).

关 键 词：子宫肉瘤 免疫组化 子宫肌瘤 鉴别诊断 

分 类 号：R737.33[医药卫生—肿瘤]