胸腔镜胸膜活组织检查联合免疫组织化学诊断恶性胸腔间皮瘤

Thoracoscopic pleural biopsy combined with immunohistochemistry for diagnosis of malignant pleural mesothelioma

目的:探讨胸腔镜胸膜活组织检查联合免疫组织化学(组化)在恶性胸腔间皮瘤临床诊断中的应用价值。方法:通过视频胸腔镜检查(video-assisted thoracoscopic surgery,VATS)进行胸膜取材活检确诊恶性胸腔间皮瘤79例为观察组,胸活确诊163例肺腺癌作为对照组,采用常规HE染色联合应用免疫组织化学SP法检测钙结合蛋白(calretinin),癌胚抗原(carcinoembryonic antigen,CEA),CD15,细胞角蛋白(cytokeratin,CK 5/6),E-钙黏着蛋白(E-cadherin)、上皮膜抗原(epithelial membrane antigen,EMA),间皮细胞蛋白(mesothelial cell,MC)、鼠源的单克隆抗体31(mouse monoclonal antibody31,Moc-31)、甲状腺转录因子1(thyroid transcription factor-1,TTF-1)、血栓调节蛋白(thrombomodulin)、波形蛋白(vimentin)、肾母细胞瘤1蛋白(Wilms’tumor 1,WT-1)的表达并进行统计学分析。结果:观察组79例恶性胸膜间皮瘤中,上皮型48例、双相型22例、肉瘤样型9例。恶性胸膜间皮瘤和肺腺癌的免疫表型分析,间皮细胞相关抗体calretinin,WT-l,CK5/6和MC的表达在观察组和对照组间差异有统计学意义(P<0.01);CEA,CD15,E-cadherin,MOC-31,TTF-1,vimentin及thrombomodulin的表达在两组间差异也有统计学意义(P<0.01);而EMA的表达在两组间差异无统计学意义(P>0.05)。对免疫组织化学染色结果采用logistic回归分析,结果显示进入回归方程的自变量是E-cadherin和TTF-1(P<0.01)。结论:VATS胸膜活组织检查联合免疫组化检查,能提高恶性胸腔间皮瘤诊断的准确性,E-cadherin和TTF-1阴性是发生恶性胸腔间皮瘤的危险因素,阳性时多发肺腺癌。

Objective： To investigate the role of thoracoscopic pleural biopsy combined with immunohistochemistry in diagnosis of malignant pleural mesothelioma. Methods： Altogether 79 patients with malignantmesothelioma （diagnosed by biopsy via video-assisted thoracoscopic surgery） and 63 patients with pulmonary adenocarcinoma were allocated to the research group and the control group, respectively. The HE staining and immunohistochemical SP assay was conducted to detect the expression of calretinin, carcinoembryonic antigen （CEA）, CD15, cytokeratin （EK）5/6, E-cadherin, epithelial membrane antigen （EMA）, mesothelial cell （MC）, mouse monoclonal antibody 31 （MO C-31）, thyroid transcription factor- 1 （TFF- 1）, thrombomodulin, vimentin and Wilms＇ tumor 1 （WT-1）. Logistic regression analysis was applied to analyze the results of two groups. Results： In the research group, there were 48 patients with epithelial type, 22 with bipolar type, and 9 with sarcomatoid type among 79 patients. The immunohistochemistry revealed that there were significant differences between the research and the control groups in the expression of mesothelial cell-associated antibodies （calretinin, WT-1, CK5/6 and MC）（P〈0.01） and other proteins （CEA, CD15, E-cadherin, MOC-31, TTF-1, and vimentin） （P〈0.01）, whereas there was no significant difference in EMA expression between the two groups. The logistic regression analysis demonstrated that the two independent variables in the regression equation were E-cadherin and TTF-1 （P〈0.01）. Conclusion： Thoracoscopic pleural biopsy combined with immunohistochemistry can improve the accuracy of diagnosis for malignant pleural mesothelioma. Low expressions of E-cadherin and TIFF- 1 are the risk factors for malignant pleural mesothelioma while high expression of the two proteins means at high risk for lung adenocarcinoma.