TTF-1、CK7在肺腺癌所致胸腔积液鉴别诊断中的价值

Analysis of immunochemistry examination of TTF-1,CK7 in the differential diagnosis of malignant pleural effusion caused by pulmonary adenocarcinoma

目的:评估甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)和细胞角蛋白7(cytokeratin7,CK7)免疫组织化学染色在肺腺癌和肺外肿瘤所致的恶性胸腔积液鉴别诊断中的价值。方法:收集我院2009年10月-2011年10月经病理学证实的恶性胸腔积液患者82例,选取其中胸膜转移性肺腺癌和肺外肿瘤胸膜转移者59例纳入分析。计算胸腔积液脱落细胞免疫组织化学染色中TTF-1、CK7对胸膜转移性肺腺癌和肺外恶性肿瘤胸膜转移的诊断灵敏度和特异度,评估此二项指标在鉴别诊断中的应用价值。结果:TTF-1、CK7在胸膜转移性肺腺癌的表达高于胸膜转移的肺外恶性肿瘤(P<0.001);TTF-1在胸膜转移性肺腺癌诊断中的灵敏度为82.2%(37/45),特异度为100.0%(14/14)。CK7在胸膜转移性肺腺癌诊断中的灵敏度为95.6%(43/45),特异度为42.9%(6/14)。肺腺癌胸膜转移的患者中CK7(+)/TTF-1(+)的阳性率明显高于乳腺癌胸膜转移患者的阳性率(P<0.001);乳腺癌胸膜转移患者中CK7(+)/TTF-1(-)的阳性率明显高于肺腺癌胸膜转移患者的阳性率(P<0.05)。结论:胸腔积液脱落细胞的TTF-1、CK7免疫组织化学染色有助于胸膜转移性肺腺癌和肺外恶性肿瘤胸膜转移的鉴别,当CK7(+)/TTF-1(+)时,诊断肺腺癌胸膜转移的特异性更高;而CK7(+)/TTF-1(-)对乳腺癌胸膜转移的诊断更具特异性。

Objective：To evaluate the value of the immunochemistry staining of thyroid transcription factor-1 （TTF-1） and CK7 （cytokeratin7） in the differential diagnosis of malignant pleural effusion caused by pulmonary adenoma and the extra-pulmonary cancer.Methods：To collect the malignant pleural cases from respiratory department and oncology department from 2009 to 2011,totally 82 cases were diagnosed by exfoliated cells of pleural effusion and/or biopsy of pleura.The study involved the cases of metastatic pulmonary adenocarcinoma and the extra-pulmonary cancer,totally 59 cases （metastatic pulmonary adenocarcinoma 45 cases and the extra-pulmonary cancer 14 cases）.To evaluate the diagnosis sensitivity and specificity of TTF-1 and CK7 of the exfoliated cells of pleural effusion to the diagnosis of malignant pleural effusion.Results：The expression of TTF-1 and CK7 in the metastatic pulmonary adenocarcinoma was higher than that of the extra-pulmonary cancer （P〈0.05）.The diagnosis sensitivity,specificity,positive predictive value and the negative predictive value of TTF-1 in the metastatic pulmonary adenocarcinoma were 82.2%（37/45）,100.0%（14/14）,100%（37/37）,63.6%（14/22） respectively.The diagnosis sensitivity,specificity,positive predictive value and the negative predictive value of CK7 in the metastatic pulmonary adenocarcinoma were 95.6%（43/45）,42.9%（6/14）,84.3%（43/51）,75.0%（6/8） respectively.The combined expression of CK7（＋）/TTF-1（＋） in the metastatic pulmonary adenocarcinoma was higher than the metastatic mammary cancer （P〈0.001） while the combined expression of CK7（＋）/TTF-1（-） in the metastatic mammary cancer staining of TTF-1 and CK7 of exfoliated cells of pleural effusion has practical performance and application value on the differential diagnosis of malignant pulmonary adenoma and the extra-pulmonary cancer.Conclusion：The combined application of TTF-1 and CK7 produced higher specificity for the pulmonary adenocarinoma and metastatic mammary cancer,the combined expression of CK7（＋）/TTF-1（＋） was more specific for the metastatic pulmonary adenocarcinoma while the combined expression of CK7（＋）/TTF-1（-） was more specific for the metastatic mammary cancer.