肺癌锁骨上淋巴结转移的最优免疫组化诊断指标

Optimal immunohistochemical diagnostic index for supraclavicular lymph node metastasis in lung cancer

目的探求诊断肺癌锁骨上转移的最优免疫组化(IHC)指标。方法在符合循证医学原则的前提下,对临床上135例肺癌锁骨上淋巴结转移患者进行淋巴结活检,选取7个抗体进行检测。将135例患者分为两类,A类110例,B类25例。其中A类又包括:通过组织学分析显示存在肺内原发病灶的14例;通过细胞学检测显示存在肺内原发病灶的43例;通过临床放射学分析显示存在肺内原发病灶的53例。B类,通过组织学分析证明存在肺外病灶的25例。待检抗体包括CK7、CK20、EMA、CEA、TTF-1、SPB以及波形蛋白。结果单个抗体在推断肺内原发病灶过程中所表现的灵敏度和特异度分别为:CK7(90.0%、56.0%),CK20(98.0%、40.0%),EMA(90.9%、4.0%),CEA(80.9%、36.0%),TTF-1(62.7%、100.0%),SPB(65.6%、100.0%),波形蛋白(60.9%、60.0%)。四联抗体(CK7、CK20、TTF-1、SPB)表现出了最高的灵敏度(85.0%)和特异度(100.0%),这使得肺癌在临床上有很高的检出率(80.0%)。结论循证医学理论前提下分析研究IHC结果对指导外科病理学的实践具有重大意义。

Objective To explore the optimal immunohistochemical （IHC） diagnostic index for supraclavicular lymph node metastasis in lung cancer. Methods In the premise of conforming to the evidence-based medicine,the biopsy of lymph node in 135 patients with supraclavicular lymph node metastasis was performed and 7 antibodies were selected to be detected. 135 cases were divided into two classes：class A （110 cases） and B （25 cases）. The class A included 14 cases of primary lesion inside the lung by the histological analysis,43 cases of primary lesion inside the lung by the cytological detection and 53. cases of primary lesion inside the lung by the radiographic analysis. The class B included 25 cases of lesion outside the lung by the histological analysis. The detecting antibodies included CKT,CK20, EMA, CEA, TTF-1, SPB and vimentin. Results The sensitivity and specificity of single antibody for deducing the primary lesion inside the lung were 90.0% and 56.0% for CK7,98.0% and 40.0% for CK20,9G 9% and 4.0% for EMA,80.9% and 36.0% for CEA,62.7% and 10G 0% for TTF-1,65.6% and 100.0% for SPB,and 60.9% and 60.0% for vimentin. The quadruple antibodies （CK7 ,CK20, TTF-1 and SPB） showed the highest sensitivity（85.0%） and highest specificity （100.0%） ,which made the relatively high detection rate （80.0%） of lung cancer in clinic. Conclusion Analyzing and researching the IMC results is of great significance to guide the surgical pathological practice based on the evidence-based medicine.