荧光原位杂交及免疫组织化学检测乳腺癌中人表皮生长因子受体2表达的比较

Comparison between fluorescence in situ hybridization and immunohistochemistry in detection of expression of human epidermal growth factor receptor 2 in breast cancer

目的 探讨浸润性乳腺癌中人表皮生长因子受体2（HER-2）基因扩增及HER-2蛋白表达与患者临床病理特征的关系.方法 105例浸润性乳腺癌患者肿瘤组织采用免疫组织化学（IHC）和荧光原位杂交（FISH）进行检测,对比HER-2蛋白表达结果及HER-2基因扩增状态,分析两者表达的相关性及与临床病理特征的关系.结果 105例浸润性乳腺癌患者中HER-2基因扩增35例.IHC检测HER-2蛋白0及＋（阴性）、＋＋（不确定）、＋＋＋（阳性）与FISH检测HER-2基因扩增的符合率分别为94.5%（17/18）、23.5%（16/68）、94.7%（18/19）.HER-2基因扩增与雌激素受体、孕激素受体的表达及淋巴结转移有相关性（均P〈0.05）,而与年龄及肿瘤分化程度无关（均P〉0.05）.结论 浸润性乳腺癌预后与HER-2基因扩增具有相关性.浸润性乳腺癌中HER-2蛋白表达阴性、 阳性的患者可选择性采用FISH进行确认;HER-2蛋白表达不确定的患者应常规采用FISH检测HER-2基因扩增状态,为临床治疗方案及判断预后提供数据.

Objective To investigate the relationship between human epidermal growth factor receptor 2 （HER-2） gene amplification, the expression of HER-2 protein and the clinical characteristics in invasive breast cancer. Methods 105 patients with invasive breast cancer were examined by immunohistochemistry （IHC） and fluorescence in situ hybridization （FISH）. The correlation between expression of HER-2 protein and the gene amplification of HER-2 was compared, and their relationship with clinicopathologic features was analyzed. Results 105 patients with invasive breast cancer included 35 cases of HER-2 gene amplification. The coincidence rates of HER-2 protein 0 and ＋ （negative）, ＋＋ （uncertainty）,＋＋＋ （positive） and FISH detection of HER-2 gene amplification were 94.5 % （17/18）, 23.5 % （16/68） and 94.7 % （18/19） respectively. HER-2 gene amplification was associated with estrogen receptor, progesterone receptor expression and lymph node metastasis （all P〈 0.05）, but not with age and tumor differentiation （P〉0.05）. Conclusions The prognosis of invasive breast cancer is correlated with the amplification of HER-2 gene. Patients with HER-2 protein negative and positive can be selectively confirmed by FISH; patients with HER-2 protein uncertainty should routinely use FISH to detect HER-2 gene amplification status, which could provide data for the clinical treatment and prognosis judgement.