液基细胞学联合免疫细胞化学在痰液脱落细胞诊断非小细胞肺癌中的应用

The non-small cell lung cancer diagnosis by thinprep cytology test and immunocytochemistry in sputum exfoliated cells

背景与目的:肺癌中非小细胞肺癌(non-small cell lung cancer,NSCLC)发病率最高,NSCLC痰液脱落细胞学诊断已成为肺癌早期诊断的重要辅助手段。本研究旨在探讨液基细胞学和免疫细胞化学方法在NSCLC恶性痰液脱落细胞学标本的分类与诊断中的应用价值。方法:应用液基薄层细胞学自动涂片技术方法筛查到可疑肿瘤细胞及肿瘤细胞的恶性痰液标本共530例进行细胞包埋连续切片,分别作NSCLC肿瘤细胞标志物细胞角蛋白7(cytokeratin-7,CK7)、细胞角蛋白5/6(cytokeratin-5/6,CK5/6)、甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)、P63、上皮膜抗原(epithelial membrane antigen,EMA)免疫细胞化学染色。结果:530例NSCLC恶性痰液患者确诊为肺腺癌265例,鳞癌246例,腺鳞癌19例。TTF-1和CK7在腺癌中有明显高表达,阳性表达率为92.45%(245/265)和91.70%(243/265);CK5/6和P63在鳞癌中有明显高表达,阳性表达率为97.15%(239/246)和99.59%(245/246)。结论:液基细胞学与免疫细胞化学技术相结合在痰液标本诊断中有很重要的临床意义,CK7、CK5/6、TTF-1、P63、EMA联合可用于NSCLC恶性痰液的分类与诊断,值得在临床细胞病理学诊断中推广应用。

Background and purpose： The non-small cell lung cancer （NSCLC） has been the highest disease incidence in lung cancer, spu^rn cytology diagnosis has become an important adjunct to the early diagnosis of lung cancer. The purpose of this study was to investigate the value of thinprep cytological and immunocytochemical method in differentiatial diagnosis ofexfoliated cells of malignant sputum in NSCLC. Methods： Sputum samples were detected with thinprep cytology test, a total of 530 cases suspicious tumor cells and malignant tumor cells sputum specimens were randomly selected in continuous paraffin-embedded sections, respectively, NSCLC tumor cell markers CK7, CK5/6, TTF-1, P63, EMA were evaluted by immunocytochemical staining. Results： Of the 530 cases of malignant sputum, these were confirmed 265 cases of lung adenocarcinoma, 246 cases of squamous carcinoma, 19 cases of adeno-squamous carcinoma. Moreover, TTF-I and CK7 were significantly higher expressed in adenocarcinoma, the positive rates were 92.45% （245/265） and 91.70% （243/265）; CK5/6 and P63 were significantly higher expressed in squamous carcinoma, the positive rates were 97.15% （239/246） and 99.59% （245/246）. Conclusion： Liquid-based cytology combined with immunocytochemistry had important clinical value in classification and identification of sputum samples, the combination of CK7, CK5/6, TTF-1, P63, EMA can be used for classification and identification of mali^-nant soutum samples between NSCLC. is worthy of nromoting, in clinical cvtoDathology diamaosis.