Pax8、CK7和CK20在卵巢原发性黏液肿瘤与转移性消化道黏液腺癌鉴别诊断中的意义

Differential diagnosis significance of Pax8,Ck7 and Ck20 in primary ovarian mucinous tumors and metastatic ovarian mucinous adenocarcinoma from digestive tract

目的探讨联合检测Pax8、CK7和CK20在卵巢原发性黏液肿瘤和转移性消化道黏液腺癌鉴别诊断中的意义。方法应用免疫组化SP法检测CK7、CK20和Pax8在61例卵巢原发性黏液肿瘤(交界性肿瘤52例,黏液腺癌9例)和17例转移性消化道黏液腺癌中的表达情况。结果 CK7和Pax8在卵巢原发性黏液肿瘤和转移性消化道黏液腺癌中的阳性率差异显著(P<0.01),CK20的阳性率差异不显著(P>0.05);CK7(+)/CK20(-)在卵巢原发性黏液肿瘤中的表达明显高于转移性消化道黏液腺癌(P<0.05),CK7(-)/CK20(+)在卵巢原发性黏液肿瘤中的表达明显低于转移性消化道黏液腺癌(P<0.01),CK7(+)/CK20(+)和CK7(-)/CK20(-)在这两种肿瘤中的表达差异不显著(P>0.05)。CK7(+)/CK20(-)/Pax8(+)在这两种肿瘤中的表达差异显著(P<0.05)。CK7(+)/CK20(-)检测的敏感度为0.6471,特异度为0.8361,ROC曲线下面积(AUC)为0.7941;CK7(+)/CK20(-)/Pax8(+)检测的敏感度为0.7647,特异度为0.8033,AUC为0.8664。结论联合检测CK7/CK20/Pax8可提高鉴别诊断卵巢原发性黏液肿瘤与转移性消化道黏液腺癌的敏感度及AUC,具有更高的准确性。Pax8在两种肿瘤的鉴别诊断中可作为一个重要的免疫组化补充检测指标。

Objective To investigate the differential diagnosis significance of Pax8,CK7 and CK20 in primary ovarian mucinous tumors and metastatic ovarian mucinous adenocarcinoma from digestive tract. Methods Immunohistochemical study for Ck7,Ck20 and Pax8 was carried out in 61 cases of primary ovarian mucinous tumors and 17 cases of metastatic ovarian mucinous adenocarcinoma from digestive tract. Results The expression differences of CK7 and Pax8 in primary ovarian mucinous tumors and metastatic ovarian mucinous adenocarcinoma from digestive tract were statistically significant（ P〈0. 001）,but there was no statistically significant in expression of CK20（ P〈0. 05）. The expression of CK7 ＋/CK20-in primary ovarian mucinous tumors was significantly higer than that in metastatic ovarian mucinous adenocarcinoma from digestive tract（ P〈0. 05）,and the expression of CK7-/CK20 ＋ in primary ovarian mucinous tumors was significantly lower than that in metastatic ovarian mucinous adenocarcinoma from digestive tract（ P〈0. 001）,while there were no statistically significant differences in expression of CK7 ＋/CK20 ＋ and CK7-/CK20-（ P〉0. 05）. The expression difference of CK7 ＋/CK20-/Pax8 ＋ in primary ovarian mucinous tumors and metastatic ovarian mucinous adenocarcinoma from digestive tract was statistically significant（ P〈0. 05）. The sensitivity,specificity and areas under Roc curve（ AUC）of CK7 ＋/CK20-immunophenotype for differential diagnosis of primary ovarian mucinous tumors and metastatic ovarian mucinous adenocarcinoma from digestive tract were 0. 6471,0. 8361 and 0. 7941,the immunophenotype CK7 ＋/CK20-/Pax8 ＋ had a sensitivity of 0. 7647, a specificity of 0. 8033 and AUC of 0. 8664. Conclusion A panel of immunohistochemical markers Pax8,CK7 and CK20 could improve the sensitivity and AUC of the differential diagnosis of primary ovarian mucinous tumors and metastatic ovarian mucinous adenocarcinoma from digestive tract,with increased specificity. Pax8 is considered as an useful adjunct in this respect.