Clusterin、CXCL13、Podoplanin(D2-40)、CD21与CD35对滤泡树突细胞肉瘤的诊断价值评价

Comparison of diagnostic values of Clusterin,CXCL13,Podoplanin,CD21 and CD35 in follcular dendritic cell sarcoma

目的探讨Clusterin、CXCL13、Podoplanin(D2-40)、CD21、CD35对滤泡树突细胞肉瘤(follcular dendritic cell sarcoma,FDCS)的诊断价值。方法采用免疫组化Eli Vision法检测10例FDCS及12种需与之鉴别的非FDCS肿瘤(包括孤立性纤维性肿瘤、平滑肌肉瘤、胃肠间质瘤等,累计83例)中上述5种标志物的表达状况,比较各标志物对FDCS的诊断效能。结果(1)FDCS组中Clusterin、CXCL13、D2-40、CD21与CD35的阳性率依次为100%、70%、60%、90%与80%。相应对照组中的阳性率依次为30%、4%、11%、2%与0。(2)5种标志物对FDCS的诊断效能,可评归为3组:A组,包括CD21与CD35,具有良好的诊断敏感度(90%,80%)、特异性(100%,98%)及准确率(98%,96%);B组,包括CXCL13与D2-40,其诊断敏感度(70%,60%)、特异性(96%,89%)与准确率(94%,86%)不及A组;C组为Clusterin,其诊断敏感度最高(100%),但特异性(70%)与准确率(73%)低于A、B两组。(3)CD21+CD35平行联合检测的诊断敏感度、特异性、准确率、阳性预测值、阴性预测值依次为100%、98%、98%、83%、100%。结论 (1)CD21与CD35对FDCS的诊断效能最为理想,且二者平行联合检测优于单项检测,可作为FDCS首选的诊断标志物。(2)Clusterin对FDCS诊断敏感度最高,但其在非FDCS肿瘤中广谱表达,制约了其应用价值。(3)CXCL13与D2-40可用于FDCS的辅助诊断,因诊断效能低于A组,不建议作为一线抗体。(4)非FDCS肿瘤中,Clusterin与D2-40的表达较常见,且偶见CD21或CXCL13的异常表达,诊断实践中关注上述特征,有助于避免误诊。

Purpose To evaluate the diagnostic values of Clusterin, CXCL13, Podoplanin （D2-40）, CD21 and CD35 in follcular den-dritic cell sarcoma. Methods The expression levels of 10 cases of follcular dendritic cell sarcoma （ FDCS） and 12 types of FDCS mimics （83 cases in total） were investigated by immunohistochemical methods, the latter including solitary fibrous tumor, leiomyosar-coma, gastrointestinal stromal tumor and others. The diagnostic validities of the five biomarkers were compared. Results （ 1 ） The positive rates of Clusterin, CXCL13, D2-40, CD21 and CD35 in the FDCS group were 100%, 70%, 60%, 90% and 80%, respec-tively, the corresponding rates in the control group were 30%, 4%, 11%, 2% and 0 in turn. （2） The five biomarkers could be cate-gorized into 3 groups, according to their diagnostic values in FDCS. The first group included CD21 and CD35, which had much higher sensitivities （90%, 80%）, specificities （100%, 98%） and accuracies （98%, 96%）, compared with the other biomarkers. The second group included CXCL13 and D2-40, which had a relatively lower sensitivities （70%, 60%）, specificities （96%, 89%） and accuracies （94%, 86%）, compared with CD21 and CD35. The third group included Clusterin, which had the highest sensitivity （100%）, while the specificity （70%）and accuracy （73%） were inferior to the first and second groups. （3） The diagnostic values of CD21 and CD35 combination were 100%, 98%, 98%, 83% and 100%, respectively. Conclusions （1） CD21 and CD35 are the most valuable biomarkers for FDCS. The combined diagnostic effect of the two markers is generally superior to that of single marker. （2） Clusterin has the highest sensitivity for FDCS. However, the frequent expression in FDCS mimickers restricts its diagnostic values for FDCS. （3） CXCL13 and D2-40 may be used as a marker for FDCS, but are not recommended as the first selection based on their diagnostic performance. （4） On the reasons that FDCS mimickers may not uncommonly express Clusterin and D2-40, and rarely show positivity for CD21 or CXCL13, more attention should be paid to the phenomenon to avoid misdiagnosis.