D2-40／CK19鸡尾酒双酶标记法在甲状腺乳头状癌淋巴管侵犯诊断中的应用

Clinical application of cocktail double enzyme labeled antibody（D2-40/CK19）staining for the diagnosis of lymphatic vessel invasion in papillary thyroid carcinoma

目的：分析淋巴管侵犯与甲状腺乳头状癌临床病理特征的关系。方法采用组合式单克隆抗体标记法和免疫组织化学鸡尾酒双酶标记法检测甲状腺乳头状癌标本D2-40、CK19抗原的表达情况，比较两种方法在甲状腺乳头状癌淋巴管侵犯诊断中的意义，并分析影响淋巴管生成的因素。结果甲状腺乳头状癌HE染色＋组合式单克隆抗体标记法和免疫组织化学鸡尾酒双酶标记法检测出淋巴管内癌栓的阳性率分别为37．5％（39／104）和53．8％（56／104），差异有统计学意义（P＜0．05）。淋巴管癌栓阳性组淋巴结转移率为83．9％（47／56），显著高于无癌栓组22．9％（11／48， P＜0．01）。淋巴管癌栓在年龄≥45岁组中的阳性率显著高于＜45岁组（ P＜0．05）。随着肿瘤直径的增加，淋巴管癌栓的检出率有明显增高的趋势（P＝0．063）。结论免疫组织化学鸡尾酒双酶标记法比HE染色＋组合式单克隆抗体标记法更能检测出甲状腺乳头状癌的淋巴管癌栓，有利于评估患者的淋巴结转移情况及其预后。随着年龄的增加，肿瘤直径的增大，淋巴管癌栓也有明显增多的趋势。

Objective To analyse the relationship between lymphatic vessels invasion and clinical pathological features of papillary thyroid carcinoma （ PTC ） .Methods The expressions of D2-40 and CK19 were examined in the 104 specimens of PTC using immunohistochemical staining with combined monoclonal antibodies and cocktail double enzyme labeled antibody（ D2-40/CK19） stainings.The two methods were compared in the diagnosis of PTC metastasis, and the factors affecting lymphatic vessels formation were analyzed.Results The positive rate of lymphatic vessels invasion was 37.5%（39/104） by using immunohistochemical staining with combined monoclonal antibodies and 53.8%（ 56/104 ） by cocktail double enzyme labeled antibody （ D2-40/CK19 ） staining （ P〈0.05）.The lymph node metastasis rate was 83.9%（47/56） in the group with lymphatic vessels invasion, significantly higher than that without invasion 22.9%（11/48, P〈0.01）.The age of patients, diameter of primary tumor were the influence factors of lymphatic vessels invasion in PTC patients（P〈0.05 and P=0.063）.Conclusion Cocktail double enzyme labeled antibody （ D2-40/CK19 ） staining is a better method to detect lymphatic vessels invasion in PTC than immunohistochemical staining with combined monoclonal antibodies.