肺小活检标本中P16表达对肺小细胞癌的诊断价值

Diagnostic value of P16 in small biopsy specimens in lung small cell carcinoma

目的探讨在肺小活检中一组免疫组化标记物(P16、CD56、Syn、CgA、TTF-1、P40)对小细胞肺癌(small cell lung cancer,SCLC)和鳞状细胞癌(squamonus cell carcinoma,SCC)的鉴别诊断意义。方法收集阜阳市人民医院2019年7月至2021年6月原发性SCLC小活检标本74例和SCC小活检标本70例,应用免疫组化方法检测P16、Syn、CgA、CD56、TTF-1及P40的阳性表达情况,分析其在SCLC和SCC鉴别诊断中的应用价值。结果P16、CD56、Syn、CgA、TTF-1的鉴别诊断阈值均为阳性表达,P40为阴性表达,接受者工作特征曲线(receiver operating characteristic,ROC)-曲线下的面积(area under curve,AUC)分别为0.83、0.96、0.88、0.70、0.88、0.93。准确度最高的指标为CD56(95.83%,138/144),其次为P40(93.06%,134/144)和P16(83.33%,120/144)。关联性检验表明6项指标均与SCLC的鉴别诊断相关联(P16、CD56、Syn、CgA、TTF-1、P40的χ^(2)值分别为61.31、117.45、79.73、27.94、81.33、103.38,P值均<0.05),优势性检验表明仅CD56、P40、P16与金标准病理方法相对一致(χ^(2)值分别为0.17、0.10、0.04,P值均>0.05)。结论P16在肺小活检标本小细胞癌中具有较高的阳性检出率、准确度,与CD56、TTF-1、Syn、CgA免疫组化指标联合应用可作为后续肺小细胞癌诊断的可行方案。

Objective To investigate differential diagnosis of a group of immunohistochemical markers(p16,CD56,syn,CGA,TTF-1 and P40)in small cell lung cancer(SCLC)and squamous cell carcinoma(SCC).Methods Small biopsy specimens from 144 cases of primary small cell lung cancer(74 cases)and squamous cell carcinoma(70 cases)in Fuyang People's Hospital from July 2019 to June 2021 were collected.The positive expressions of p16,syn,CGA,CD56,TTF-1 and P40 were detected by immunohistochemistry,and their application value in the differential diagnosis of SCLC and SCC was analyzed.Results The differential diagnostic thresholds of p16,CD56,syn,CGA and TTF-1 were positive and P40 was negative.The receiver operating characteristic(ROC)-area under curve(AUC)were 0.83,0.96,0.88,0.70,0.88 and 0.93,respectively.The highest accuracy index was CD56(95.8%,138/144),followed by P40(93.1%,134/144)and p16(83.3%,120/144).The correlation test showed that the six indexes were associated with the differential diagnosis of SCLC(the χ^(2) values of p16,CD56,syn,CGA,TTF-1 and P40 were 61.31,117.45,79.73,27.94,81.33 and 103.38,respectively,all P values<0.05).The dominance test showed that CD56,P40 and p16 were relatively consistent with the gold standard pathological method(theχ^(2) values were 0.17,0.10 and 0.04,respectively,all P values>0.05).Conclusion p16 has a high positive detection rate in SCLC of lung biopsy specimens accuracy,combined with CD56,TTF-1,syn and CGA immunohistochemical indexes,may be used as a feasible scheme for the subsequent diagnosis of SCLC.