与细胞形态相结合的荧光原位杂交技术在纤维支气管镜刷检细胞学诊断肺癌中的价值

Fluorescence in situ hybridization combined with cytomorphology for the detection of lung cancer in bronchial brushing specimens

目的探讨与细胞形态相结合的荧光原位杂交（FISH）技术在纤维支气管镜刷检细胞学诊断肺癌中的价值。方法选取7、8及17号染色体着丝粒探针（CEPs），对69例纤维支气管镜细胞学标本进行与细胞学形态学相结合的FISH检测。结果FISH检测显示，在细胞学诊断为癌细胞中，CEP7、CEP8和CEP17的阳性率分别为50.0%、80.8.%和65.4%，CEP8与CEP7的阳性率差异有统计学意义（P＝0.015）。在细胞学诊断为可疑癌细胞中，CEP7、CEP8和CEP17的阳性率分别为46.6%、66.7%和58.8%。在细胞学诊断为非典型细胞中，CEP7、CEP8和CEP17的阳性率分别为20.0%、33.3%和25.0%。CEP7、CEP8、CEP17在可疑癌和非典型细胞间的差异均无统计学意义（均P〉0.05），在癌与可疑癌细胞间的差异均无统计学意义（均P〉0.05）。所有良性细胞均未见染色体异常改变。肺腺癌中CEP7、CEP8和CEP17的阳性率均高于肺鳞状细胞癌和小细胞肺癌，但仅肺腺癌与小细胞肺癌的CEP8阳性率差异有统计学意义（P＝0.044）。以CEP7、CEP8、CEP17任一阳性为标准，其与细胞形态相结合的FISH诊断肺癌的敏感度为80.3%，特异度为100.0%。细胞学诊断肺癌的敏感度为54.1%，特异度为100.0%。结论与细胞形态相结合的FISH技术可以辅助诊断纤维支气管镜刷检细胞学中不能确诊的患者（可疑癌及非典型细胞），从而提高纤维支气管镜刷检细胞学诊断肺癌的敏感度，且不降低其诊断的特异度。

ObjectiveTo evaluate the diagnostic value of fluorescence in situ hybridization （FISH） combined with bronchial brushing cytology for detecting lung cancer.MethodsCentromeric enumeration probes （CEPs） for chromosomes 7, 8 and 17 were used in FISH assay. The combination of FISH and cytology was analyzed in 69 bronchial brushing specimens.ResultsThe positive rates of CEP7, CEP8 and CEP17 in malignant cases diagnosed by cytology were 50.0%, 80.8% and 65.4%, respectively. CEP8 probe showed significantly higher positive rate than CEP7 （P=0.015）. In the samples of suspicious of malignancy, the positive rates of CEP7, CEP8 and CEP17 were 46.6%, 66.7% and 58.8%, respectively. While in atypical cases, the positive rates of these three probes were 20.0%, 33.3% and 25.0%, respectively. There was no statistical difference between suspicious of malignancy and atypical cases （P〉0.05） as well as between malignant and suspicious of malignancy （P〉0.05）. No chromosome aberrations were found in normal cases diagnosed by cytology. The positive rates of these three probes in adenocarcinoma （ADC） were slightly higher than those in squamous cell carcinoma and small cell lung cancer. However, only CEP8 probe showed statistically difference between ADC and small cell lung cancer （P=0.044）. The combination of cytology and FISH using any one of the three-probe set （CEP7, CEP8 and CEP17） showed the sensitivity and specificity of 80.3% and 100.0%, while those of cytology were 54.1% and 100.0%, respectively.ConclusionsFISH combined with cytomorphology assisted the cytology diagnosis of suspicious of malignancy and atypical cases. Therefore, it significantly improved the diagnostic sensitivity for lung cancer without sacrificing specificity.