乳腺癌患者核芯针穿刺标本和外科手术标本免疫组化结果的一致性探讨

Concordance of immunohistochemical results of core needle biopsy specimens and surgery specimens for breast cancer

目的 比较乳腺癌患者核芯针穿刺标本（core needle biopsy,CNB）和外科手术标本（surgery specimen,SS）免疫组化检查结果的一致性. 方法 回顾性分析2012-08 ～ 2013-11就诊于宣武医院普外科的乳腺癌病人资料,其中术前核芯针穿刺及术后标本均有免疫组化结果的病例55例,比较两者雌激素受体（estrogen receptors,ER）、孕激素受体（progesterone recep-tors,PR）、表皮生长因子受体2（human epidermal growth factor receptor 2,HER2）的表达情况. 结果 在55例中,核芯针穿刺标本和外科手术标本HER2免疫组化结果差异具有统计学意义（P＜0.05）;核芯针穿刺的标本在ER、PR、HER2等免疫组化指标的阳性表达常高于外科手术标本.同时在CNB标本及SS标本ER、PR、HER2免疫组化结果的一致率较高,分别为90％,86.7％,和79.3％;相似性检验中,Kappa值分别为0.791,0.881,0.404. 结论 在乳腺癌指标ER,PR和HER2的表达上,核芯针穿刺标本的结果和外科手术标本的结果虽有差别,但一致度高.当核芯针与外科手术标本免疫组化不一致时,核芯针穿刺标本结果可能更可靠.

Objective To explore the concordance of immunohistochemical results of preoperative core needle biopsy （CNB） and surgery specimen（SS） in breast cancer patients.Methods From August 2012 to November 2013,the immunohistochemical results from both core needle biopsy and surgery specimens of 55 patients with breast cancer were collected.The levels of estrogen receptors（ER）,progesterone receptors （PR）,and HER2 were detected and compared between core biopsy specimens and surgical specimens.Results HER2 positive rate was significantly higher in core needle biopsy specimens than that of surgical specimens （P ＜ 0.05）.The positive rates of ER and PR expression were higher in core needle biopsy specimens than those in surgery specimens.The concordance of immunohistochemical results of ER,PR and HER2 in core needle biopsy and surgery specimens were 90％,86.7％,and 79.3％,respectively.Using kappa statistics,the concordance between CNB and SS was almost perfect for ER（k =0.791） and PR（k =0.881）,and substantial for HER2（k =0.404）.Conclusion CNB has a high coincidence with SS in evaluating ER,PR,and HER2 status in breast cancer patients.When CNB and surgical samples are discordant,the results of core biopsy samples may be more accurate.