免疫细胞化学方法对胸腔积液中恶性肿瘤细胞的分类与诊断

Classification and identification of malignant tumor cells by IHC in pleural effusion diagnosis

目的应用免疫细胞化学对胸腔积液中的肺非小细胞癌分类与恶性间皮瘤的鉴别诊断。方法利用液基薄层细胞学自动涂片技术方法对筛查出的胸腔积液可疑瘤细胞及瘤细胞标本1158例进行细胞包埋连续切片,分别作肺非小细胞癌(NSCLC)肿瘤细胞标记物CK7、CK5&6、TTF-1、E-ca及恶性间皮瘤标记物MC(Mesothelial Cell,MC)、CR(Calretinin,CR)、P53、Vimentin免疫细胞化学染色。结果 1158例胸腔积液患者确诊为肺腺癌581例,鳞癌509例,腺鳞癌48例,恶性间皮瘤20例。TTF-1在腺癌中有明显高表达,阳性表达率为92.43%;CK5&6在鳞癌中有明显高表达,阳性表达率为97.45%;MC、CR在恶性间皮瘤中有明显高表达,阳性表达率为100.00%和95.00%。结论液基细胞学与免疫细胞化学技术相结合在胸腔积液鉴别诊断中有很重要的临床意义,CK7、CK5&6、TTF-1、E-ca联合应用可用于胸腔积液中NSCLC之间的分类与诊断,CK5&6、MC、CR、P53、Vimentin联合应用可用于胸腔积液中间皮瘤的定性诊断,值得在临床细胞病理学诊断中推广应用。

Objective To make differentiatial diagnosis of non-small cell cancer and malignant mesothelioma in pleural effusion by immunocytochemical method. Methods Pleural effusion was detected with TCT, and a total of 1158 cases of suspected or confirmed tumor cells of malignant pleural effusion were randomly selected in continuous paraffin-embedded sections. We detected non-small cell lung cancer （NSCLC） cell markers CKT, CK5＆6, TTF-1 and E-ca, and malignant mesothelioma markers MC （Mesothelial Cell）, CR（Calretinin）, P53 and Vimentin immunocytochemical staining. Results Of the 1158 cases of pleural effusion, we confirmed 581 cases of lung adenocarcinoma, 509 squamous carcinoma,48 adeno-squamous carcinoma, and 20 malignant pleural mesothelioma. Moreover, TTF-1 showed significantly higher expression in adenocarcinoma, with a the positive percentage 92.43%; CK5＆6 showed significantly higher expression in squamous carcinoma, with 97.45%;MC and CR showed significantly higher expressions in malignant pleural mesothelioma, with 100.00% and 95.00%. Conclusion Liquid-based cytology combined with immunocytoehemistry is of clinical significance in classification and identification of pleural effusion. The combination of CKT, CK5＆6, TTF-1, E-ca can be used for classification and identification of NSCLC, while the combination of CK5＆6, MC, CR, P53, and Vimentin can be used for qualitative diagnosis of pleural mesothelioma, so they are worthy of promoting in clinical cytopathological diagnosis.