胸腔积液脱落细胞免疫组织化学染色检测相关抗体对胸膜转移性肺腺癌和恶性胸膜间皮瘤的鉴别诊断价值

Value of Immunohistochemical Detection of Relevant Antibodies in the Exfoliated Cells of Pleural Effusion in the Differential Diagnosis of Malignant Pleural Mesothelioma and Metastatic Pulmonary Adenocarcinoma

目的评估胸腔积液脱落细胞的波形蛋白(vimentin,VIM)、神经特异度钙结合蛋白(calretinin,CR)、细胞角蛋白7(CK7)、甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)免疫组织化学染色在胸膜转移性肺腺癌和恶性胸膜间皮瘤鉴别诊断中的价值。方法收集我科2009年9月—2011年10月经胸腔积液细胞学诊断或胸膜活检病理学证实的42例恶性胸膜间皮瘤(11例)和胸膜转移性肺腺癌(31例)患者纳入分析。计算胸腔积液脱落细胞免疫组织化学染色中VIM、CR、CKT和TTF-1 4项指标诊断胸膜转移性肺腺癌和恶性胸膜间皮瘤的灵敏度和特异度,评估4项指标在鉴别诊断中的应用价值。结果恶性胸膜间皮瘤患者的VIM、CR、CK7、TTF-1的阳性表达率与胸膜转移性肺腺癌患者比较,差异均有统计学意义(P<0.05)。VIM在恶性胸膜间皮瘤诊断中的灵敏度为91%(10/11),特异度为52%(16/31),阳性预测值为40.0%,阴性预测值为94.1%。CR在恶性胸膜间皮瘤诊断中的灵敏度为82%(9/11),特异度为84%(26/31),阳性预测值为62.9%,阴性预测值为92.9%。CK7在胸膜转移性肺腺癌诊断中的灵敏度为94%(29/31),特异度为82%(9/11),阳性预测值为81.8%,阴性预测值为76.3%。TTF-1在胸膜转移性肺腺癌诊断中的灵敏度为77%(24/31),特异度为91%(10/11),阳性预测值为96.0%,阴性预测值为58.8%。结论胸腔积液脱落细胞的VIM、CR、CKT和TTF-1免疫组织化学染色对恶性胸膜间皮瘤和胸膜转移性肺腺癌的鉴别诊断具有较高应用价值。

Objective To assess the values of the immunochemistry staining of vimentin （ VIM）, calretinin （ CR）, cytokeratin7 （ CK7）, and thyroid transcription factor - 1 （ TTF - 1 ） in the differential diagnosis of malignant pleura1 mesothelio- ma （MPM） and metastatic pulmonary adenocarcinoma （MPA）. Methods Totally 11 MPM patients and 31 MPA patients who were treated in our department from September 2009 to October 2011 were enrolled in this study. The levels of VIM, CR, CK7, and TTF - 1 in the exfoliated cells of pleura1 effusion were determined using immunohistochemical method to evaluate their speci- ficity and sensivitiy in the differential diagnosis of MPM and MPA. Results The expressions of VIM, CR, CK, and TTF - 1 showed significant differences between the MPM group and MPA group （ P 〈 0. 05 ）. The sensitivity, specificity, positive predic- tive value, and negative predictive value of VIM for the diagnosis of MPM were 91% , 52% （ 16/31 ）, 40. 0% , 94. 1%, re- spectively, and those of CR were 82% （9/11）, 84% （26/31）, 62.9%, 92.9% respectively. The diagnosis sensitivity, specificity, positive predictive value, and negative predictive value of CK7 for the diagnosis of MPA were 94% （29/31）, 82% （9/11）, 81.8%, 76. 3%, respectively, and those of TTF - 1 were 77% （24/31）, 91% （ 10/11 ）, 96. 0%, and 58.8%, respectively. Conclusion The immunohistochemistry of VIM, CR, CK7, and TTF - 1 in the exfoliated cells of pleural effusion is valuable for the differential diagnosis of MPM and MPA.