肺癌活检小标本ICM-DNA定量分析在诊断中的应用

Clinical significance of ICM-DNA Content Analysis in Fiberoptic Bronchoscopic Specimens of Lung Cancer

目的：为了进一步了解肺癌细胞生物学行为，评价肺小标本ＩＣＭ—ＤＮＡ含量检测对肺癌的诊断价值。方法：选取纤维支气管镜活检肺小标本 ９５例，其中肺癌组 ６４例［包括鳞状上皮细胞癌（简称鳞癌）４５例，腺癌 ９例，小细胞未分化癌１０例］，肺良性病变（炎症）组３１例。将肺小标本石蜡包块以５μｍ连续切片，分别作ＨＥ染色和Ｆｅｕｌｇｅｎ 染色，后者进而用国际标准化 ＣＡＳ－２００型 图像细胞仪（ＩＣＭ）检测 ＤＮＡ含量。分析指标包括 ＤＮＡ质量、ＤＮＡ指数（ＤＩ）、增殖指数（ＰＩ）、Ｓ期百分比、核面积、直方图类型及倍体状况等。结果：肺癌组细胞核ＤＮＡ质量、ＤＩ、ＰＩ、Ｓ％和核面积等指标均明显高于肺炎症组（Ｐ＜０．０５或Ｐ＜０．０１）；肺癌组ＤＮＡ直方图类型主要为Ⅲ型和Ⅵ型（占７９．７％），未见Ⅰ型；而肺炎症组相反，无１例为Ⅲ型和Ⅵ型，多呈Ⅰ型改变（９０．３％），两组之间有显著差异（Ｐ＜０．０１）；两组的细胞核 ＤＮＡ 倍体状况存在极显著差异（Ｐ＜０．０１），肺癌组多为异倍体，异倍体检出率达９６．９％，而肺炎症组均为二倍体。以异倍体为标准，结合Ｓ期百分比，诊断肺癌的敏感性为９６．７％，特异性达１００％。结论：应用ＩＣＭ检测纤维支气管?

Objective To evaluate the diagnostic value of ICM-DNA content analysis in fiberoptic bronchosoopic specimens of lung cancer. Methods: DNA contents in fiberoptic specimens from 64 patients with lung cancer including 45 cases of squamous cell carcinoma, 9 cases of adenocarcinolna, 10 cases of small cell carcinoma and 31 patients with benign lung lesions (inflammation) were measured with CAS-200 image cytometry (ICM). Results: (1) DNA contents which included DNA weight, DNA index (DI), proliferation index (PI), percentage of S-phase and nuclear area were significantly higher in lung cancer group than that in benign lung lesion group (P<0.05 or P<0.01). (2) DNA ploidy patterns of lung cancer group were mainly in type Ⅲ or type Ⅳ (79.7%), but the type Ⅰ picture was not to be found. On the contrary, the patterns of benign lung lesion group were almost in type Ⅰ (90.3%), but none in type Ⅲ and type Ⅳ (P< 0.01). (3) The rate of aneuploid was 96.9% in lung cancer group and 0% in benign lung lesion group which showed diploid (euploid) at all (100%). (4) When we use aneuploid to diagnose lung cancer, the sensitivity rate was 96.9% and the specificity was 100%. Conclusion: DNA content analysis in fiberoptic bronchoscopic specimens by means of ICM has an adjunctive value in diagnosis of lung cancer. The aneuploid is an objective, reliable and important marker of lung cancer.