乳管镜乳腺导管冲洗液细胞学检查和Her2、P21和P53蛋白表达对乳腺导管肿瘤的诊断价值

Study on cytological examination and expression of Her2, P21 and P53 proteins of ductoscopic ductal lavage and their clinical significances in patients with tumor of breast duct

目的评价乳管镜下收集乳腺导管冲洗液细胞学检查和乳腺导管冲洗液脱落细胞Her2、P21、P53蛋白表达对乳腺导管良恶性肿瘤的诊断意义。方法在乳管镜直视下对46例乳腺导管癌和58例乳腺导管内乳头状瘤患者的乳腺导管病变进行搔刮,收集冲洗液打点涂片。用巴氏法行细胞学检查,用免疫细胞化学染色法行乳腺导管冲洗液脱落细胞的Her2、P21和P53蛋白检测。用χ2检验和秩和检验进行统计学分析。结果乳头溢液涂片上皮细胞量少,细胞往往有变性改变,核浓缩,结构均质化;乳腺导管冲洗液涂片细胞量丰富,核染色深,细胞形态保持完整。乳头溢液涂片中有效细胞团明显少于乳腺导管冲洗液涂片中的有效细胞团(P<0.01)。58例导管内乳头状瘤中,乳头溢液涂片细胞学诊断为良性57例,可疑恶性1例;乳腺导管冲洗液涂片细胞学诊断为良性56例,可疑恶性2例;两者比较差异无显著性(P>0.05)。14例伴有乳头溢液的乳腺癌患者乳头溢液涂片细胞学诊断的准确性明显低于46例乳腺癌患者的乳腺导管冲洗液细胞学检查(P<0.05)。46例乳腺导管癌乳腺导管冲洗液脱落细胞的Her2、P21和P53蛋白阳性表达率明显高于47例乳腺导管内乳头状瘤患者(P<0.05)。结论在乳管镜下收集乳腺导管冲洗液细胞学涂片的有效细胞团明显多于乳头溢液细胞学涂片,乳腺导管冲洗液细胞学检查诊断乳腺癌的准确性明显提高。免疫细胞化学方法检测乳腺导管冲洗液脱落细胞的Her2、P21和P53蛋白可作为鉴别乳腺导管良恶性肿瘤的参考指标。

[Objective] To study on cytological examination and expression of Her2, [21 and P53 proteins of ductoscopic ductal lavage and their diagnostic value in patients with tumour of breast duct. [Methods] 104 patients （46 cases with ductal carcinoma and 58 cases with intraductal papilloma） were examined by fiberoptic ductoscopy. Abnormal intraduct of breast lesions were scraped with biopsy needle under ductoscopy and then the duct was washed with 0.9% NS solution. The ductal lavage was collected for cytological examination with papanicolaou staining and to detect the expression of Her2, P21, P53 gene proteins with immunocytochemical staining. [Results] The ductal lavage obtained more adequate cytological specimens than nipple discharge （P 〈0.01）. The diagnostic accuracy of cytological examination in ductal lavage was similar to that of the nipple discharge in 58 cases with intraductal papilloma （P 〉0.05）. The diagnostic accuracy of cytological examination in ductal lavage was significantly higher than that of the nipple discharge in 46 cases with ductal carcinoma （P 〈0.05）. The positive rates of Her2, P21 and P53 proteins in exfoliative cells of ductal lavage were higher in 46 cases with ductal carcinoma than that of 47 cases with intraductal papilloma （P 〈0.05）. [Conclusions] The results showed that ductoscopic ductal lavage in patients with tumour of breast duct could provide much more adequate specimens for cytological examination and increase the diagnostic accuracy. The expressions of Her2, P21, P53 gene proteins in the exfohative cells of ductal lavage may contribute to distinguishing benign from malignant breast ductal diseases.