免疫组化在乳腺良、恶性疾病鉴别诊断中的意义

Roles of P63 and smooth muscle actin protein in differential diagnosis of breast benign and malignant lesions

目的探讨单克隆抗体P63、平滑肌肌动蛋白(smooth muscle actin,SMA)在乳腺疑难病变鉴别诊断中的价值。方法收集乳腺疑难病例48例,采用S-P免疫组化染色法,同时标记P63和SMA。结果34例乳腺良性病变可见P63、SMA阳性的肌上皮细胞,不典型增生及导管原位癌的导管或腺泡周围可见P63、SMA阳性的肌上皮细胞,浸润性癌中不见P63、SMA阳性的肌上皮细胞。有时P63呈不均匀的间断表达,SMA除标记肌上皮细胞,还与间质肌纤维母细胞和血管平滑肌细胞等成分有交叉反应。结论同时检测P63、SMA识别肌上皮细胞有助于提高乳腺疾病的诊断准确率,HE染色始终是乳腺疾病诊断的基础。

Objective To investigate P63 and smooth muscle actin（SMA） protein expression and its significance in breast lesion diagnosis. Methods Forty-eight cases of breast lesions which were difficult to diagnose were selected, S-P immunohistochemistry was used to detect P63 and SMA protein. Results Two antigens were positive in the vast majority of myoepithelial cells in all 34 cases of benign breast lesions and 11 cases of dysplasia and ductal carcinoma in situ. Myoepithelial cells marked by the two antibodies weren＇ t seen in 3 cases of invasive breast carcinoma. Some cases of benign lesions showed focal gaps in the myoepithelial cell layer, reflecting in discontinuous positive immunostaining around ductal structure. All cases showed SMA expression in myofibroblasts and vascular smooth muscle cells. Conclusion P63 and SMA may be useful myoepithelial cell markers and could be helpful for recoganizing myoepithelial cells as in breast lesions which are difficult to be diagnosed. However, HE staining is still the base of diagnosis of breast lesions.