胸水细胞蜡块在肺癌诊断和EGFR基因检测中的应用研究

Application of cell blocks of pleural effusion in diagnosis of lung carcinoma and detection of EGFR gene mutation

目的探讨胸水细胞蜡块结合免疫组织化学染色技术在肺癌诊断和EGFR基因检测中的应用价值。方法胸水标本常规离心、涂片后,沉渣包埋制成细胞蜡块,结合免疫组织化学染色明确诊断,应用ARMS-PCR法检测175例肺腺癌EGFR基因突变情况,并与同期活检或手术的305例肺腺癌组织块的EGFR基因突变进行对比。结果细胞蜡块结合免疫组织化学染色的癌细胞检出率高于常规涂片者(P <0.05),且不确定构成比低于后者(P <0.05)。用细胞蜡块与组织块检测EGFR基因突变的阳性率及男女构成比比较,差异无统计学意义(P>0.05)。结论胸水细胞蜡块可作为实体瘤组织的良好替代样品,有助于明确肿瘤类型、来源,并可用于肺癌的EGFR基因突变检测,有效指导其分子靶向治疗。

Objective To explore the significance of the application of cell blocks of pleural effusion combined with immunohistochemistry in the diagnosis of lung carcinoma and detection of EGFR gene mutation.Methods After the pleural effusion specimens were centrifuged and smeared routinely,the cell sediments were embedded in paraffin to make cell blocks.Combined with immnohistochemistry technique,the definite diagnoses were made.EGFR mutations of cell blocks of 175 cases with lung adenocarcinomas were detected by ARMS-PCR method and compared with the mutations of EGFR gene of biopsy or operation spcimens of 305 cases of lung adenocarcinomas.Results The cancer cell detection rate of cell blocks combined with immunohistochemistry was higher than that of the conventional smears(P<0.05),and the ratio of uncertainty was lower than that of the latter(P<0.05).There was no significant difference in the positive rate of EGFR gene mutation or the male-to-female ratio between cell blocks and tumor tissues(P>0.05).Conclusions Pleural fluid cell block can be a good substitute for solid tumor tissue,which is helpful in identifying the tumor type and source.And it can be used for the detection of EGFR gene mutations in lung carcinomas,which can effectively guide the molecular targeted therapy.