多项联合检测在肺腺癌与鳞癌鉴别诊断中的价值

Value of multiple joint detection in the differential diagnosis of lung adenocarcinoma and squamous cell carcinoma

目的探讨p40、天冬氨酸蛋白酶A(novel aspartie proteinase A,Napsin A)及甲状腺转录因子(thyroid transcription factor-1,TTF-1)联合检测在肺腺癌与鳞癌鉴别诊断中的价值。方法分析于本院行肺癌手术的41例腺癌和30例鳞癌患者p40、Napsin A及TTF-1的表达,结合临床病理资料进行统计分析。结果p40在腺癌中不表达,在鳞癌中的阳性率为100%。TTF-1在腺癌中的阳性率为80.48%,显著高于鳞癌的7.69%(P<0.05),Napsin A在鳞癌中不表达,在腺癌中的阳性率为95.12%,显著高于TTF-1(P<0.05)。在腺癌中Napsin A和TTF-1在伴有淋巴结转移的、TNM分期Ⅲ-Ⅳ期的患者中的阳性率显著高于无转移、Ⅰ-Ⅱ期的患者(P<0.05);对鳞癌患者,在伴有淋巴结转移的TTF-1的阳性率显著高于无转移的患者(P<0.05)。Napsin A单指标检测诊断腺癌的敏感性为88.57%,特异性为94.41%,TTF-1单指标检测诊断腺癌的敏感性为80.49%,特异性为92.31%,均低于Napsin A。两者联合检测的敏感性为96.13%,特异性为100%,高于单指标检测。结论 p40、Napsin A及TTF-1的检测是鳞癌、腺癌鉴别诊断的有力依据,Napsin A和TTF-1的表达有助于预测患者的预后,联合检测能提高腺癌诊断的准确性。

Objective To investigate the clinical significance of joint detection of p40,novel aspartie proteinase A（ Napsin A） and thyroid transcription factor-1（ TTF-1） in the differential diagnosis of lung adenocarcinoma and squamous cell carcinoma.Methods The expressions of P40,Napsin A and TTF-1 in 41 patients with adenocarcinoma and 30 patients with squamous cell carcinoma were analyzed.Statistical analysis was done combined with clinicopathological data.Results p40 did not express in adenocarcinoma patients,but it was 100% positive in squamous cell carcinoma.The positive rate of TTF-1 in adenocarcinoma was 80.48%,which was significantly higher than7.69% in squamous cell carcinoma（ P〈0.05）.Napsin A did not express in squamous cell carcinoma,but its positive rate of Napsin A in adenocarcinoma was 95.12%,which was significantly higher than that of TTF-1（ P〈0.05）.In adenocarcinomas,the positive rate of Napsin A and TTF-1 in patients with lymph node metastasis or in TNM stage Ⅲ-Ⅳ were significantly higher than those in patients without metastasis,stage I-II（ P〈0.05）.In squamous cell carcinoma patients,the positive rate of TTF-1 with lymph node metastasis was significantly higher than that of patients without metastatic（ P〈0.05）.In adenocarcinoma,the sensitivity of Napsin A was 88.57%,and the specificity was 94.41%,while the sensitivity of TTF-1 was 80.49%,and the specificity was 92.31%,which were both lower than Napsin A.The sensitivity and specificity of the joint detection was 96.13% and 100%,higher than the single-index test.Conclusion The detection of p40,Napsin A and TTF-1 is a powerful basis for the differential diagnosis of squamous cell carcinoma and adenocarcinoma.The expression of Napsin A and TTF-1 is helpful to predict the prognosis of patients,and the combined detection can improve the diagnostic accuracy of adenocarcinoma.