胰腺超声内镜细针穿刺活检组织中粘蛋白表达检测辅助诊断胰腺癌的价值评价

The value of mucin expression profile in endoscopic ultrasound-guided fine needle aspiration pancreatic speci-mens in diagnosing pancreatic cancer

目的检测粘蛋白(MUC1、MUC2、MUC5AC)在胰腺超声内镜细针穿刺(EUS-FNA)组织标本中的表达,评价其对胰腺癌辅助诊断的价值。方法收集54例胰腺占位病变的EUS-FNA组织标本。采用S-P免疫组化法检测粘蛋白(MUC1、MUC2、MUC5AC)的表达,根据临床综合判断的诊断.与细胞学检查结果比较,评价其诊断价值。结果54例患者最后确诊为胰腺癌38例,胰腺良性肿瘤6例,慢性胰腺炎10例。细胞学和组织学的诊断敏感性分别为31.6%和47.4%。MUC1、MUC2、MUC5AC在胰腺痛EUS-FNA标本组织中的阳性表达率为81.6%(31/38)、10.5%(4/38)、84.2%(32/38),在胰腺良性疾病组织标本中分别25%(4/16)、31.3%(5/16)、43.8%(7/16),其中MUC1和MUC5AC两组间差异有统计学意义(P<0.01)。MUC1的表达与胰腺癌的临床分期、淋巴结转移呈正相关。将细胞组织学检查结合MUC1和MUC5AC表达检测诊断胰腺癌的敏感性可提高至89.5%。结论胰腺EUS-FNA组织标本中MUC1、MUC5AC的检测对胰腺癌有临床辅助诊断价值,且MUC1还能预测胰腺癌的临床分期及淋巴结转移。

Objeetive To detect mucin（MUCl, MUC2, MUCSAC） expressions in endoscopic ultrasound-guided fine needle aspiration（EUS-FNA） specimens of the pancreatic neoplasms lesions and evaluate their diagnostic value. Methods The expression profile of MUCl,MUC2, MUCSAC from 54 EUS-FNA samples of pancreatic occupying lesions were examined by immunohistochemistry with mono- clonal antibodies. The results were correlated to the cytohistologic and clinical diagnosis of pancreatic cancer. Results Thirty-eight of the 54 patients had pancreatic cancer, 6 patients had benign tumor, 10 patients had chronic pancreatitis. The sensitivites of cytology and histology in diagnosing pancreatic cancer were 31.60% and 47.4%, respectively. The prevalence of MUCl, MUC2 and MUCSAC expres- sion in EUS-FNA samples of pancreatic cancer were 81.6%（31/38）, 10. 5%（4/38）, 84.2%（32/38）, respectively, and those in benign pancreatic neoplasms were 25% （4/16）, 31. 3% （5/16）, 43. 8 （7/16）, respectively. There was statistically significance in MUCland MUC5AC expression between the two groups（P 〈 0.01）. Furthermore, MUCl expression in pancreatic cancer had positive correlation with clinical stage and lymphatic metastasis. Combined measurement of MUCl and MUC5AC expression and cytohistologic analysis in EUS-FNA specimens could increase sensitivity to 89. 5% in diagnosing pancreatic cancer. Conclusions Determination of MUCl and MUC5AC expression in EUS-FNA specimens from pancreatic tissue will be helpful in diagnosing pancreatic cancer. In addition, MUCl expression can predict the clinical stages and lymphatic metastasis of cancer.