FISH检测老年肺癌胸水细胞块与组织EGFR的对比研究

The comparative study of FISH detected EGFR gene for cell blocks of pleural effusion and tissue of lung cancer in elderly patients

目的:对比老年非小细胞肺癌(NSCLC)患者胸水细胞块与组织EGFR基因扩增情况,探讨晚期NSCLC患者癌性胸水对临床肺癌诊断分型及EGFR基因突变检测的利用价值。方法:临床送检经我院病理科在细胞学涂片明确找到癌细胞的老年NSCLC患者新鲜胸水30例,癌性胸水通过常规离心、涂片后,沉渣包埋制成石蜡细胞块,进行免疫组织化学染色(IHC)明确病理诊断,通过荧光原位杂交(FISH)检测肺癌EGFR基因扩增情况,并对比同一患者活检或手术病理组织。结果:30例细胞蜡块与相应30例组织块进行比较,免疫组化诊断病理类型是一致的,其中肺腺癌15例,肺鳞状细胞癌13例,其他类型NSCLC2例;胸水细胞蜡块中肺腺癌EGFR基因突变阳性的有7例,肺鳞癌中EGFR基因突变阳性的有6例,其他类型NSCLC中EGFR基因突变阳性1例,组织学检测肺腺癌EGFR基因突变阳性的有8例,肺鳞癌中EGFR基因突变阳性的有6例,其他类型NSCLC中EGFR基因突变阳性1例;两者比较EGFR基因突变一致率为93. 3%,差异无统计学意义(P> 0. 05)。结论:胸水细胞蜡块对于部分肺癌晚期患者可较好的代替实体肿瘤组织用于明确肺癌类型及EGFR基因突变检测,从而为临床治疗筛选靶向药物提供分子病理学指导。

Objective: To compare the EGFR gene amplification of the pleural fluid cell blocks and tissues in elderly patients with non-small cell lung cancer, and to explore the application value of malignant pleural effusion in patients with advanced non-small cell lung cancer in the diagnostic typing of clinical lung cancer and the detection of EGFR gene mutation. Methods: To collect 30 cases of aged non-small cell lung cancer patients with fresh pleural effusion whose cancer cells were clearly found on the cytological smear by the department of pathology of our hospital for clinical examination,The malignant pleural effusion samples were centrifuged, smeared and precipitated into paraffin-embedded cell mass. And then the diagnosis was confirmed by immunohistochemistry. The amplification of EGFR gene was detected by fluorescence hybridization (FISH), and compared with the corresponding biopsy or surgical tissues. Results: The results of immunohistochemical diagnosis were completely consistent between the 30 cases of cell wax mass and the corresponding 30 cases of tissue mass, including 15 cases of patients with lung adenocarcinoma and 13 cases of lung squamous carcinoma, other types of non-small cell lung cancer in 2 cases, lung adenocarcinoma in pleural effusion cells wax block EGFR mutation positive in 7 cases, EGFR gene mutation in lung squamous carcinoma positive in 6 cases, other types of non-small cell lung cancer in EGFR mutation positive in 1 case, histological detection of EGFR mutation positive patients with lung adenocarcinoma in 8 cases, EGFR gene mutation in lung squamous carcinoma positive in 6 cases, other types of non-small cell lung cancer in EGFR mutation positive in 1 case;The consistency rate of EGFR gene mutation was 93.3%, and the difference was not statistically significant ( P >0.05). Conclusions: For some patients with advanced lung cancer, the pleural fluid cell blocks can better replace solid tumor tissue for lung cancer type determination and EGFR gene mutation detection, so as to provide molecular pathological guidance for clinical treatment and screening of targeted drugs.