细胞角蛋白亚型和TTF-1判断癌性体腔积液原发灶的价值

Value of Cytokeratin Subtypes and Thyroid Translation Factor-1 in Identification of the Primary Focus of Cancerous Body Cavity Effusions

目的:评价细胞角蛋白亚型(CKs)和甲状腺转录因子-1(TTF-1)对判断癌性体腔积液原发灶的价值。方法:收集100例新鲜体腔积液,其中62例为癌性积液,5例非上皮性恶性体腔积液,33例为良性积液。采用石蜡包埋细胞块技术和免疫细胞化学技术对100例体腔积液标本检测CK5/6,CK7、CK18、CK19、CK20和TTF-1的表达状况。结果:CK5/6表达见于肺、子宫颈和食管来源的鳞癌细胞。CK18表达仅见于腺癌细胞。CK5/6(+)/CK18(-)检测鳞癌细胞的敏感性为83.3%,特异性为100%。CK5/6(-)/CK18(+)检测腺癌细胞的敏感性为89.8%,特异性为100%。CK7(-)/CK20(+)仅见于大肠腺癌。肺腺癌细胞TTF-1表达阳性率为78.6%,小细胞癌阳性率为100%。TTF-1诊断肺腺癌细胞的敏感性为78.6%,特异性为97.1%。结论:单独的细胞角蛋白亚型检测对于判断体腔积液癌细胞来源具有局限性,采用组合细胞角蛋白各亚型和TTF-1对于判断体腔积液癌细胞来源仍有重要参考价值。

Objective： To evaluate cytokeratin subtypes and thyroid translation factor-1 （TTF-1） in identification of the primary focus of cancerous body cavity effusions. Methods： A total of 100 cases with fresh body cavity effusions （62 cancerous effusions, 5 malignant non-epithelial body cavity hydrops and 22 benign effusions） were examined for expression of cytokeratin subtypes （including CK5/6, CK7, CK18, CK19 and CK20） and TTF-1 using paraffin-embedded cell blocks and immunocytochemistry. Results： CK5/6 was expressed in squamous carcinoma cells from the cervix, esophagus and lung. CK18 was expressed in adenocarcinoma cells. CK5/6 （＋）/CK18 （-） identified squamous cell carcinoma with 83.3% sensitivity and 100% specificity. CK5/6（-）/CK18（＋） identified adenocarcinoma with 89.8% sensitivity and 100% specificity. CK7 （-）/CK20 （＋） identified large intestine adenocarcinoma with 100% sensitivity and 100% specificity, TTF-1 was detected in 78.6% of the adenocarcinoma cells and in 100% of the small cell lung carcinoma cells that were examined, TTF-1 identified adenocarcinoma of the lung with 78.6% sensitivity and 97.1% specificity. Conclusion： An individual cytokeratin subtype has a limited role in identifying the specific primary focus of cancerous effusions, but combining cytokeratin and TTF-1 expression profiles has great value for identifying the primary focus of cancerous body cavity effusions.