导管冲洗液脱落细胞Her2和P53蛋白表达及其对乳腺良恶性肿瘤的鉴别意义

EXPRESSIONS OF Her2 AND P53 PROTEIN OF EXFOLIATIVE CELLS IN DUCTAL LAVAGE AND THEIR DIFFERENTIAL VALUES BETWEEN BENIGN AND MALIGNANT TUMOUR IN BREAST DUCT

目的:探讨乳腺导管冲洗液脱落细胞Her2、P53蛋白的表达在乳腺良恶性肿瘤鉴别的诊断价值。方法:对42例乳头溢液患者溢液的乳管行乳管镜检查,并收集冲洗液细胞,用巴氏染色行细胞学检查,S-P法免疫细胞化学法检测冲洗液脱落细胞Her2和P53蛋白的表达。结果:42例中,病变切除病理诊断为乳腺癌10例,诊断为乳腺导管内乳头状瘤32例。在乳腺导管冲洗脱落细胞学检查中,10例乳腺癌患者中有5例诊断为乳腺癌,4例诊断为可疑乳腺癌,1例未见异常导管上皮。乳腺导管内乳头状瘤32例,诊断为导管内乳头状瘤8例,可疑瘤10例,可疑癌2例,未见异常上皮12例。在免疫化学检查中,10例乳腺癌患者中有6例导管冲洗液脱落细胞Her2蛋白阳性表达,3例P53蛋白阳性表达;32例在导管内乳头状瘤导管冲洗液脱落细胞中无Her2蛋白阳性表达,1例P53蛋白阳性表达。乳腺癌导管冲洗液脱落细胞Her2蛋白和P53蛋白表达的阳性率均明显高于导管内乳头状瘤(P<0.05)。结论:乳腺导管冲洗液脱落细胞学检查对乳腺良恶性肿瘤诊断的准确性高,检测乳腺导管冲洗液脱落细胞Her2、P53蛋白的表达对鉴别诊断乳腺肿瘤的良恶性有一定的帮助。

Objective： To improve the methods of immunocytochemistry to examined Her2 and P53 proteins of exfoliative cells in ductal lavage and to evaluate their differential values between benign and malignant tumor in breast duct. Methods： From July 2003 to October 2004, 42 patients with nipple discharge were examined by fiberoptic ductoscopy. Abnormal points of breast ducts were scraped with biopsy needle under ductoscopy and then the ducts were washed with 0.9% NS solution. The ductal lavage was collected for .exfoliative cytology and immunocytochemistry to examine Her2 and P53 proteins of exfoliative cells. The accuracy was evaluated between histopathologic finding of ductal lesions and exfoliative cytology, Her2 and P53 proteins of exfoliative cells in all patients. Result： The histopathologic findings of 10 cases were interpreted as breast carcinoma, 32 as papillomas. The exfoliative cytology in 10 cases with breast carcinoma revealed 5 carcinomas, 4 suspicious-carcinomas and 1 negative-carcinoma. The exfoliative cytology in 32 cases with papillomas revealed 2 suspicious-carcinomas, 8 papillomas, 10 suspicious-papillomas and 12 negative-papilloma. 6 were positive-Her2 and 3 were positive- P53 in 10 cases with breast carcinoma. None was positive-Her2 and 1 was positive-P53 in 32 cases with papillomas. Positive-Her2 and positive-P53 of exfoliative cells were significantly higher in breast carcinoma than papillomas （ P〈0.05）. Conclusion： The exfoliative cytology of ductal lavage is quite accurate in diagnosing the tumour in breast duct. Immunocytochemical detections of Her2 and P53 proteins of exfoliative cells in ductal lavage are useful for distinguishing benign from malignant tumor in breast duet.