胰液细胞抑癌蛋白表达检测在胰腺癌诊断中的价值

DETECTION OF ANTI-ONCOGENE PRODUCTS ASAN ADJUNCT IN CYTOLOGIC EXMINATION OF PURE PANCREATIC JUICE FOR DIAGNOSIS OF PANCREATIC CARCINOMA

目的 :在胰液细胞形态学的基础上 ,探讨免疫细胞化学检测抑癌蛋白的表达异常在提高胰腺癌鉴别诊断方面的价值。方法 :共 2 0例进行ERCP术并静注 10 0u促胰泌素收胰液。胰液经离心后行细胞涂片。胰液细胞涂片进行巴氏染色 ,并采用免疫细胞化学EnvisionSystem检测 p16 ,p2 1,p5 3和 p2 7蛋白的表达。结果 :通过胰液细胞形态学检查 (巴氏染色 ) ,10例胰腺癌患者的胰液中 6例找到瘤细胞 ,而非癌组 10例均未找到瘤细胞。结合免疫细胞化学检测 p5 3和 p16蛋白的表达改变 ,又有 2例胰液中的可疑细胞被判断为瘤细胞 ,总阳性率为 8/ 10 (80 .0 % ) ,特异性为 10 0 .0 % ,准确性为 90 .0 %。结论 :胰液脱落细胞形态学结合免细胞化学法检测抑癌蛋白的表达异常对鉴别胰腺疾病的良、恶性有帮助。

Objective:To develop a new method of immunocytochemistry in conjunction with conventional cytologic examination of pure pancreatic juice,which can improve the diagnostic efficacy of pancreatic diseases. Method:In 20 cases,pure pancreatic juice was endoscopically collected after injection of 100 cu secretin.Pancreatic juice was centrifuged and was made as smear of cell pellets.p53,p16,p21 and p27 proteins were immunocytochemically stained respectively using Envision system in the cell smears of pancreatic juice,in addition to the usual Papanicolaou staining. Results:Cytologic examination of pancreatic juice revealed positive results in 6 of 10(60%) cases of pancreatic carcinoma by Papanicolaou staining,2 additionl cases were determined with the aid of immunocytochemical stain of p53 and p16.No positive results were encountered in 4 cases of pancreatitis and 6 control ones.Overall,the sensitivity,specificity and accuracy of cytologic examination of pancreatic juice in conjunction with immunocytochemistry were 80.0% ,100% and 90.0% respectively. Conclusions:Immunocytochemical detection of anti-oncogene products as an adjunct in cytologic examination of pancreatic juice may contribute to distinguishing benign from malignant pancreatic diseases.