| 摘要: |
| 目的 探讨胸腔积液细胞块切片免疫组化染色技术在鉴别肺腺癌与间皮病变中的临床价值。 方法 收集具有细胞 异型性的胸腔积液标本共 112 例，每例均制备细胞涂片与细胞块切片行 HE 染色，再选用细胞角蛋白 7（CK7）、癌胚抗原（CEA）、甲状 腺转录因子 -1（TTF-1）、细胞角蛋白 5/6（CK5/6）、钙结合蛋白（CR）等 5 种免疫标记对细胞块切片行免疫组化染色，比较 3 种检测方 法的阳性检出率及不同免疫标记诊断肺腺癌与间皮病变的灵敏度与特异度。 结果 对恶性胸腔积液的阳性检出率，细胞涂片 HE 染 色仅 49.3%，细胞块切片 HE 染色为 69.9%，细胞块切片免疫组化染色达 95.9%。CK7、CEA、TTF-1 在肺腺癌中高表达，CK5/6、CR 在 间皮病变中高表达。TTF-1、CK7、CEA 三者中任意两者（+）且 CK5/6 或 CR（-）对肺腺癌诊断的灵敏度达 100.0%，特异度达 96.8%。 CK5/6 或 CR（+）且 CK7、CEA、TTF-1 三者中任意两者（-）对间皮病变诊断的灵敏度达 100.0%，特异度达 98.6%。 结论 细胞块切 片免疫组化染色与细胞涂片 HE 染色相比可明显提高胸腔积液标本的阳性检出率，选择特异性免疫标记并将其合理搭配，利用不同标 记的互补与反证作用可有效鉴别肺腺癌与间皮病变，临床价值显著。 |
| 关键词: 细胞块 免疫组织化学 肺腺癌 胸腔积液 |
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| Immunohistochemistry staining by pleural effusion cell block sections in differentiation of pulmonary adenocarcinoma from mesothelial lesions |
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ZHANG Wenhuo, ZHOU Hong, LI Dandan, SUN Lijuan, XU Rujun
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Hangzhou First People's Hospital
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| Abstract: |
| Objective To assess the clinical values of immunohistochemistry staining by pleural effusion cell block sections in differential diagnosis of pulmonary adenocarcinoma from mesothelial lesions. Methods One hundred and twelve
pleural effusion specimens of cellular atypia were collected, cell smears and cell block sections were prepared. HE staining was performed in cell smears and cell block sections to observe the cell morphology; and immunohistochemistry staining was performed in cell block sections to detect the expression of cytokeratin 7 (CK7), carcino-embryonic antigen (CEA), thyroid transcription factor-1 (TTF-1), cytokeratin 5/6 (CK5/6) and calretinin (CR). The positive rates of malignant pleural effusion detected by different cytology diagnostic methods were compared. The sensitivity and specificity of different immune markers for diagnosis of pulmonary adenocarcinoma and mesothelial lesions were analyzed. Results The positive rates of malignant pleural effusion detected by cell smear HE staining, cell block HE staining, and cell block immunohistochemistry staining were 49.3%, 69.9%, and
95.9% , respectively. CK7, CEA and TTF-1 were highly expressed in pulmonary adenocarcinoma, while CK5/6 and CR were highly expressed in mesothelial lesions. With the combined application of CK7, CEA, TTF-1, CK5/6 and CR, the sensitivity and specificity for diagnosis of pulmonary adenocarcinoma were 100.0% and 96.8%, and the sensitivity and specificity for diagnosis of mesothelial lesions were 100.0% and 98.6%, respectively. Conclusion Compared with cell smear HE staining, cell block immunohistochemistry staining is more effective in diagnosis of malignant pleural effusion. Combination of specific immune markers is of clinical value in differential diagnosis of pulmonary adenocarcinoma and mesothelial lesions. |
| Key words: Cell block Immunohistochemistry Pulmonary adenocarcinoma Pleural effusion |
