P53和CEA双染色在胆管癌病理诊断中的应用

The application of P53 and CEA double staining in the pathological diagnosis of cholangiocarcinoma

目的病理组织学活检是胆管癌确诊的金标准,但在形态学上胆管癌与反应性胆管增生有时难以区分。我们探讨用免疫组化同时联合检测P53和CEA在胆管癌组织病理鉴别诊断中的辅助应用价值。方法选取胆管癌病例52例和对照组病例26例,其中肝内胆管癌48例,肝外胆管癌4例。男性31例、女性21例,年龄18~79岁。采用En Vi-sion二步法同时检测P53和CEA的表达。结果胆管癌及对照组P53表达率分别为89%、54%,然而在中等以上表达强度的统计中则胆管癌组表达率约60%,对照组则低至8%,两组具有显著统计学差异（P=0.014）。P53的表达与患者性别及标本类型无统计学差别,但在低分化肿瘤中表达强度更强（P=0.009）。胆管癌CEA表达率81%,对照组12%,中等强度以上表达则胆管癌中只有48%,对照组中未见中等以上表达强度病例（P〈0.001）。双阳细胞表达率分别75%、7%,双阳细胞表达敏感性和特异性分别为70%,95%。结论同时检测P53和CEA在胆管癌的组织病理鉴别诊断中具有实用的临床价值。

Objective Histopathological biopsy is the gold standard for diagnosis of cholangiocarcinoma, but sometimesthe morphology of the cholangiocarcinoma and reactive bile duct hyperplasia are difficult to distinguish. This study aimed toinvestigate the practical value of P53 and CEA double staining in the histopathologic differential diagnosis ofcholangiocarcinoma. Methods Fifty-two cases of cholangiocarcinoma and 26 cases of the control group were included. In theobservation group, there were 48 cases of intrahepatic cholangiocarcinoma and 4 cases of extrahepatic cholangiocarcinoma;There were 31 males and 21 females, aged from 18 to 79 years old. The expression of P53 and CEA were detectedsimultaneously by En Vision method. Results P53 expression rates in cholangiocarcinoma and control group were 89%, 54%respectively. However,the expression above middle intensity of the observation group was 60% and the control group was 8%,which had significant difference（P =0.014）. The expression of P53 did not show statistic difference among sex and sampletypes but more intensive in poorly differentiated tumors（P =0.009）. CEA expression rate was 81% of cholangiocarcinoma and12% of the control group. The expression above middle intensity of the observation group was 48%,and not seen in controlgroup（P〈0.001）.Double positive expression rates were 75% and 7%, respectively. The sensitivity and specificity of doublepositive staining were 70% and 95% respectively. Conclusion The simultaneous detection of P53 and CEA have practicalclinical value in the histopathologic differential diagnosis of cholangiocarcinoma.