免疫FISH技术检测脑脊液中循环肿瘤细胞在肺癌脑膜转移诊断中的应用

Immuno FISH technology for detection of circulating tumor cells in cerebrospinal fluid to diagnose meningeal metastasis from lung cancer

目的：探讨免疫FISH技术检测脑脊液中肿瘤细胞在肺癌脑膜转移诊断中的应用价值。方法：应用免疫FISH技术平台检测16例肺癌脑膜转移患者以及8例脑部非肿瘤疾病患者的脑脊液中循环肿瘤细胞。脑膜转移患者根据神经系统症状、增强MRI检查和脑脊液细胞学检查确诊。结果：肺癌脑膜转移患者的循环肿瘤细胞数目明显高于脑部非肿瘤疾病组,差异具有统计学意义（P〈0.01）。根据受试者工作曲线（ROC曲线）确定满足正确诊断指数（Youden指数）最大值的临界点为脑脊液循环肿瘤细胞检测阳性的判定标准,循环肿瘤细胞为1个/7.5 m L脑脊液时曲线下面积（AUC）为0.875,AUC 95%CI为0.705~1.000,诊断的敏感性为75%,特异性为100%,有效性为83.3%,阳性预测值为100.0%,阴性预测值为66.7%。结论：免疫FISH技术检测脑脊液中循环肿瘤细胞对于肺癌脑膜转移的诊断具有重要的临床意义。

Objective： To investigate the effectiveness of immuno FISH technology in detecting tumor cells in cerebrospinal fluid（CSF） for adjuvant diagnosis of meningeal metastasis from lung cancer. Methods： Circulating tumor cells（CTCs） were detected by immuno FISH technology in CSF samples from 16 patients with meningeal metastasis from lung cancer and 8 patients with non-tumorous brain diseases. Meningeal metastasis from lung cancer was diagnosed on the basis of neurological symptoms and confirmed by enhanced magnetic resonance imaging and CSF cytological examination. Results： The number of CTCs was significantly greater in patients with meningeal metastasis from lung cancer than in those with non- tumorous brain diseases（P0.01）. The critical point of the maximum correct diagnosis index（Youden index） was regarded as the judging criterion for the positive tumor cells in CSF based on the receiver operating characteristic curve. When one tumor cell existed in 7.5 m L of CSF, the area under the curve was 0.875, and the 95%confidence interval ranged from 0.705 to 1.000. The diagnostic sensitivity, specificity, effectiveness, positive predictive values, and negative predictive values were 75.0%, 100.0%, 83.3%, 100.0%, and 66.7%, respectively. Conclusion： Immuno FISH technology provides great significance in detecting CTCs in CSF to diagnose meningeal metastasis from lung cancer.