内镜超声引导下细针抽吸标本Dickkopf-1检测对胰腺癌的诊断价值

Diagnostic Value of Dickkopf-1 in Endoscopic Ultrasound-guided Fine Needle Aspiration Specimen for Pancreatic Cancer

背景:Dickkopf-1(DKK-1)是一种分泌性蛋白,作为Wnt信号通路拮抗剂,在肿瘤的发生、发展过程中起重要作用。目的:检测胰腺内镜超声引导下细针抽吸(EUS-FNA)标本中的DKK-1表达情况,评价其对胰腺癌的诊断价值。方法:收集31例胰腺占位性病变患者的EUS-FNA标本,以免疫组化方法检测DKK-1蛋白表达,并与细胞学、组织学检查和最终诊断结果进行比较。结果:31例患者中24例最终诊断为胰腺癌,7例最终诊断为良性病变。胰腺癌EUS-FNA标本中DKK-1蛋白表达阳性率为70.8%,良性病变则不表达DKK-1蛋白,组间差异有统计学意义(P<0.05)。EUS-FNA标本细胞学和组织学诊断胰腺癌的敏感性分别为58.3%和37.5%,特异性均为85.7%,两者如与DKK-1检测联合,敏感性和特异性分别提高至87.5%和100%。结论:胰腺EUS-FNA标本细胞学、组织学检查与DKK-1检测联合有助于提高胰腺癌的诊断水平。

Background： Dickkopf-1 （DKK-1） is a secreted protein that antagonizes Wnt signaling pathway. Studies indicated that DKK-1 might play a significant role in the development and progression of human cancer. Aims： To detect the expression of DKK-1 in pancreas specimen taken by endoscopic ultrasound-guided fine needle aspiration （EUS-FNA） and to estimate its diagnostic value for pancreatic cancer. Methods： Expression of DKK-1 protein in EUS-FNA specimen taken from pancreatic occupying lesion was determined by immunohistochemistry in 31 patients. The results were compared with the cytology, histology and established diagnosis. Results： Of the 31 patients, 24 were ultimately diagnosed as pancreatic cancer and 7 as benign lesion. The positivity rate of DKK-I protein was 70.8% in EUS-FNA specimen taken from pancreatic cancer, and being negative in all seven benign cases （P〈0.05）. The sensitivity of cytology and histology of EUS-FNA specimen in diagnosing pancreatic cancer were 58.3% and 37.5%, respectively, while the specificity for both was 85.7%. Combination of cytology, histology and DKK-1 detection increased the sensitivity and specificity to 87.5% and 100%, respectively. Conclusions： Combination of cytology, histology and DKK-1 detection in pancreas specimen taken by EUS-FNA would be helpful for improving the diagnosis of pancreatic cancer.