细胞角蛋白在乳腺导管内增生性病变鉴别诊断中的应用

Role of cytokeratin expression in differential diagnosis of intraductal proliferative lesions of breast

目的 研究细胞角蛋白(CK)在乳腺导管内增生性病变的表达情况,寻求帮助乳腺导管内增生性病变鉴别诊断的分子标记。方法 按Page标准选病例,收集本院1993-2002年病理标本,乳腺导管内增生性病变92例(石蜡包埋标本)、冷冻切片30例以及导管上皮普通性增生原代培养上皮细胞和浸润性导管癌细胞株T-47D和MCF-7。采用EnVision标准二步法研究CK34βE12、CK8以及CK14表达情况。结果 (1)石蜡组织中CK34BE12在导管上皮普通性增生、不典型性增生、导管原位癌以及浸润性导管癌的阳性结果分别为95.2%、33.3%、19.2%和12.5%;导管上皮普通性增生、浸润性导管癌的冷冻切片CK34βE12阳性率为100%和55%;CK34βE12在MCF7呈阴性染色,在普通性增生原代培养细胞及T-47D中呈阳性染色;(2)CK8与CK14在乳腺导管上皮普通性增生的表达模式与其他病变不同。结论 CK34BE12有助于乳腺导管内增生性病变的鉴别诊断,但还不适用于术中冷冻快速诊断;CK8与CK14在乳腺导管内增生性病变中的表达模式可有助于鉴别诊断。

Objective To evaluate the expression of cytokeratins in intraductal proliferative lesions of breast, including usual ductal hyperplasia ( UDH) , atypical ductal hyperplasia ( ADH) , ductal carcinoma-in-situ (DCIS) and its role in differential diagnosis. Methods Ninety two cases of paraffin-embedded lesional breast tissue, 30 cases of frozen samples, cell cultures of hyperplastic ductal cells and 2 invasive ductal carcinoma cell lines (T47D and MCF-7) were used for this study. Immunohistochemistry was performed using En Vision method for 34βE12, CK8 and CK14. Results The percentage of 34βE12-positivity in paraffin-embedded samples of UDH, ADH, DCIS and invasive ductal carcinoma (IDC) was found to be 95. 2% ,33. 3% ,19. 2% and 12. 5% respectively. In frozen tissues, all UDH cases and 55% of IDC cases expressed 34βE12. The primary UDH cell cultures and T47D cell line were also 34βE12-positive, whereas MCF7 cell line showed negative staining. The expression rate of CK8 and CK14 in UDH was also different from that in ADH and DCIS. Conclusions 34βE12 can be useful in differential diagnosis of intraductal proliferative lesions of the breast. However application of this cytokeratin stain in intraoperative frozen sections is relatively limited. The expression patterns of CK8 and CK14 are also helpful in the differential diagnosis of similar lesions.