胸液细胞学标本和纤支镜肺活检标本p53蛋白的检测及其意义

Clinical significance of immunohistochemical detection of p53 protein in pleural effusion and bronchial specimen

目的 探讨p53蛋白作为肿瘤标志物在肺癌诊断中的意义。方法 应用免疫组织化学方法对 57例胸液细胞学标本和 69例纤维支气管镜肺活检标本作p53蛋白的检测。结果 p53蛋白在胸液细胞学标本中保存较好 ,细胞学诊断为良性、可疑肺癌、肺癌者 ,p53蛋白阳性率分别为 0 % (0 /2 7)、3 3 .3 % (2 /6)、54 .2 % (1 3 /2 4)。纤维支气管镜肺活检标本中 ,组织学诊断为良性、不典型增生和恶性肿瘤者 ,p53蛋白阳性率分别为 0 % (0 /2 3 )、1 4.3 % (1 /7)和 3 5.9% (1 4/3 9)。上述p53蛋白阳性的可疑癌和不典型增生病例经随访均证实为肺癌。结论 检测胸液细胞学标本和纤维支气管镜肺活检标本中的p53蛋白对于胸部良恶性疾病的鉴别诊断具有重要的临床意义。

Objective To explore the usefulness of p53 immunohistochemical staining as a marker of malignancy in the diagnosis of lung cancer. Methods The expression of p53 in 57 samples of pleural effusion and 69 bronchial biopsy specimens was investigated by immunohistochemical method. Results p53 was well preserved in the samples of pleural effusion. p53 positive rate was 0%(0/27)、33.3%(2/6)and 54.2%(13/24) respectively in cytologically benign, suspicious but not conclusively malignant and malignant pleural effusion. Benign pleural effusion referred as tuberculous and other inflammatory effusion. p53 poisitive rate was 0%(0/23),14.3%(1/7) and 35.9% (14/39) in histologically benign, atypical proliferating and malignant bronchial biopsy sample. The cases with p53 immunoreactivity were proved to have lung cancer after follow up in cytologically suspicious but not conclusively malignant pleural effusion and histologically atypical proliferating bronchial biopsy sample. Conclusion p53 immunostaining could be useful as a marker of malignancy in the cytologic examination of pleural effusion and bronchial biopsy sample. The presence of p53 immunoreactivity in these samples is strongly suggestive of malignancy, though its absence does not exclude neoplasms.