对乳腺浸润性导管癌和浸润性小叶癌鉴别诊断的探讨

Differential diagnosis of invasive ductal carcinoma versus invasive lobular carcinoma of breast

目的探讨组织形态上易混淆的浸润性导管癌（IDC）与浸润性小叶癌（ILC）的鉴别诊断方法。方法收集北京大学第一医院1998年1月至2001年12月4年间普通外科诊治并有完整随访资料的IDCI级24例、ILC12例和具有混合性导管小叶特征的浸润性癌（简称混合癌）14例共50例原发性乳腺癌患者资料和标本。采用EnVision法免疫组织化学染色检NE-钙黏蛋白（E—cad）、p120连环蛋白（p120ctn）、上皮膜蛋白（EMP）1和DVL1。结果E-cad在IDCI级和ILC中的阳性率分别为83．3％（20／24）和0，其差异有统计学意义（P〈0．01）；p120ctn在IDCI级中阳性率为100．0％，且均为胞膜着色，在ILC中亦为12例均阳性，但均为细胞质着色；EMP1和DVL1在IDCI级和ILC中的阳性分别为95．8％（23／24）和12例，54．2％（13／24）和5例，其差异无统计学意义（P〉0．05）。E-cad和p120ctn联合使用将14例混合癌确诊为IDC12例和ILC2例。结论E—cad和p120ctn联合使用可以鉴别易混淆的IDC和ILC，使组织分型更准确。EMP1、DVL1不能作为鉴别IDC和ILC的指标。

Objective To study the diagnostic usefulness of immunohistochemical markers in distinguishing between invasive ductal carcinoma and invasive lobular carcinoma of breast. Methods Twenty-four cases of grade I invasive ductal carcinoma, 12 cases of classic invasive lobular carcinoma and 14 cases of invasive carcinoma with mixed ductal and lobular features were retrieved from the archival files of Peking University First Hospital during the period from January, 1998 to December, 2001. Immunohistochemical study for E-cadherin, p120 catenin ,epithelia membrane protein 1 （ EMP1 ） and DVL1 was performed. Results The positivity rates for E-cadherin in grade I invasive ductal carcinoma and classic invasive lobular carcinoma were 83.3 % （20/24） and O, respectively （ P 〈 0. 01 ）. The positivity rates for p120 catenin were 100% in both grade 1 invasive ductal carcinoma （ membranous staining） and classic invasive lobular carcinoma （cytoplasmic staining）. The positivity rates for EMP1 and DVL1 in grade I invasive ductal carcinoma were 95.8% （23/24） and 54. 2% （ 13/24 ）, respectively; while those in classic invasive lobular carcinoma were 12 and 5 cases, respectively. Conclusions E-cadherin and p120 catenin are useful immunomarkers for distinguishing between invasive ductal carcinoma and invasive lobular carcinoma. On the other hand, EMP1 and DVL1 are of limited value in this respect.