NSCLC所致恶性积液分型诊断中液基薄层联合Napsin A、CK5/6表达的临床价值

The Clinical Value of the Thin-Cytologic Test Combined with Napsin Aand CK5/6 in the Diagnosis of Malignant Pleural Effusion Caused by NSCLC

目的:通过液基薄层细胞形态学(TCT)联合免疫组织化学天冬氨酸蛋白酶A(Napsin A)及细胞角蛋白5/6(CK5/6)在胸腔积液中的表达,探讨并诊断非小细胞肺癌所致恶性胸腔积液以及其在分型诊断中的临床应用价值。方法:采用液基薄层细胞学制片技术对756例胸腔积液进行涂片,筛选出疑似肿瘤细胞及肿瘤细胞标本322例;再利用免疫组织化学染色技术对确诊为由非小细胞肺癌所致的149例恶性胸腔积液进行肺腺癌、鳞癌分型诊断,并判断该指标是否具有诊断价值。结果:初筛756例胸腔积液,149例为非小细胞肺癌所致的恶性积液,其中肺腺癌117例、肺鳞癌30例、肺腺鳞癌2例。Napsin A在肺腺癌、肺鳞癌所致恶性胸水标本中的阳性表达率分别为86.05%、10.81%,其差异具有统计学意义(P<0.05);Napsin A在肺腺癌所致恶性胸水中的灵敏度、特异度分别是86.05%、91.67%。CK5/6在肺鳞癌、肺腺癌所致恶性胸水标本中的阳性表达率分别为88.24%、11.11%,其差异具有统计学意义(P<0.05);CK5/6在肺鳞癌所致恶性胸水中灵敏度、特异度分别是88.24%、88.89%。结论:Napsin A和CK5/6分别作为诊断肺腺癌、鳞癌所致恶性胸水的指标具有重要价值;液基薄层胸腔积液细胞形态学与免疫组织化学这两种方法联合检测非小细胞肺癌所致恶性胸腔积液及其分型诊断具有较好的临床应用价值,值得推广应用。

Objective: To explore the clinical application value of Thin-Cytologic Test(TCT) combined with the Immunohistochemistry method in the classification diagnosis of malignant pleural effusion caused by non-small cell lung cancer(NSCLC), examining the expression of aspartic proteinase A(Napsin A)and Cytokeratin 5/6(CK5/6) in the pleural effusion By Thin-Cytologic Test(TCT) combined with the Immunohistochemistry method. Methods: 322 cases of suspected tumor cells and tumor cells specimen were screened out by the TCT method from 756 cases of pleural effusion. Immunohistochemistry method was used to differentially diagnose 149 cases of confirmed malignant pleural effusion caused by NSCLC for lung adenocarcinoma and squamous cell carcinoma in terms of the histological examination, with its diagnostic value determined. Results: There were 117 cases of lung adenocarcinoma, 30 cases of lung squamous cell carcinoma and 2 cases of lung adenosquamous and squamous cell carcinoma among 149 cases of malignant pleural effusion caused by NSCLC screened out from 756 pleural effusions cases. The positive expression rate of Napsin A in the malignant pleural effusion caused by lung adenocarcinoma and that caused by squamous cell carcinoma was 86.05 %、10.81% respectively. The difference was statistically significant(P<0.05). The sensitivity and specificity of Napsin A in the malignant pleural effusion caused by lung adenocarcinoma were 86.05 % and 91.67 %, respectively. The positive expression rate of CK5/6 in malignant pleural effusion caused by squamous cell carcinoma and that caused by adenocarcinoma of lung was 88.24 % and 11.11 %, respectively. The difference was statistically significant(P<0.05). The sensitivity and specificity of CK5/6 in malignant pleural effusion induced by lung squamous cell carcinoma were 88.24 % and 88.89 %, respectively. Conclusion: Napsin A and CK5/6 are important in guiding the diagnosis of lung adenocarcinoma and squamous cell carcinoma. The Thin-Cytologic Test combined with the Immunohistochemistry method is of great clinically value in the pathological diagnosis and classification of malignant pleural effusion caused by NSCLC, deserving of pouplarization in clinical practice.