CD34、CD117、BCL-2和Ki67免疫组化联合在乳腺叶状肿瘤诊断及预后判断中的应用

Application of CD34,CD117,BCL-2 and Ki67 combined immunohistochemistry in the diagnosis and prognosis of breast phyllodes tumors

目的 分析并讨论CD34、CD117、BCL-2、Ki67免疫组化联合应用在乳腺叶状肿瘤诊断及预后判断中的价值。方法 回顾广东省妇幼保健院病理科2018年10月至2021年10月诊断的乳腺叶状肿瘤标本50份,依据《乳腺肿瘤(WHO肿瘤分类系列第五版)》中关于乳腺良性、交界性和恶性叶状肿瘤的组织学特征的最新诊断标准将叶状肿瘤分为良性(n=26)、交界性(n=16)和恶性(n=8),加做免疫组化CD34、CD117、BCL-2、Ki67,并对患者进行随访,分析上述免疫组化表达情况及其与预后的相关性。结果 在乳腺良性、交界性、恶性叶状肿瘤间质细胞中,CD34弥漫表达的阳性率分别为73.08%、6.25%、0.00%,部分表达的阳性率分别为26.92%、87.50%、12.50%,差异有统计学意义(χ^(2)=55.951,P<0.001);CD117弥漫表达的阳性率分别为0.00%、0.00%、12.50%,部分表达的阳性率分别为0.00%、50.00%、62.50%,差异有统计学意义(χ^(2)=26.022,P<0.001);BCL2弥漫表达的阳性率分别为88.46%、25.00%、37.50%,部分表达的阳性率分别为11.54%、75.00%、37.50%,差异有统计学意义(χ^(2)=29.044,P<0.001);Ki67≥30%且<60%的阳性率分别为0.00%、75.00%、12.50%,Ki67≥60%的阳性率分别为0.00%、0.00%、87.50%,差异有统计学意义(χ^(2)=73.853,P<0.001)。良性叶状肿瘤的复发率为0.00%(0/26),交界性叶状肿瘤的复发率为6.25%(1/16),恶性叶状肿瘤的复发率为12.50%(1/8)。Pearson相关性分析结果显示:叶状肿瘤中Ki-67的表达与复发率呈正相关(r=0.871,P=0.032),CD34、BCL2的表达与复发率均呈负相关(r=-1.000,P<0.001;r=-1.000,P<0.001),CD117的表达与复发率不相关(r=0.723,P=0.482)。结论 CD34、CD117、BCL-2、Ki67免疫组化联合应用在乳腺叶状肿瘤诊断及预后判断中具有一定的价值,尤其对于微创手术标本或穿刺标本,可以指导临床诊治。

Objective To evaluate the value of CD34,CD117,BCL-2,Ki67 combined immunohistochemistry in the diagnosis and prognosis of breast phyllodes tumor. Methods 50 cases of breast phyllodes tumor specimens diagnosed by the Department of Pathology of Guangdong Women and Children Hospital from October 2018 to October 2021 were retrospectively analyzed. According to the latest diagnostic criteria for the histological features of benign,borderline and malignant breast phyllodes tumors in Breast Tumors(WHO classification of tumors series,5th ed),the phyllodes tumors were classified into benign(n=26),borderline(n=16)and malignant(n=8). The levels of CD34,CD117,BCL-2,and Ki67 were detected by Immunohistochemistry. The patients were followed up to analyze the above-mentioned immunohistochemical expression and its correlation with prognosis. Results In benign,borderline and malignant phyllodes tumor stromal cells,the diffuse expression positive rates of CD34 were 73.08%,6.25% and 0.00%,and the partial expression positive rates were 26.92%,87.50% and 12.50%. There were statistically significant differences(χ^(2)=55.951,P<0.001). The diffuse expression positive rates of CD117 were 0.00%,0.00% and 12.50%,and the partial expression positive rates were 0.00%,50.00% and 62.50%. There were statistically significant differences(χ^(2)=26.022,P<0.001). The diffuse expression positive rates of BCL2 were 88.46%,25.00% and 37.50%,and the partial expression positive rates were 11.54%,75.00% and 37.50%. There were statistically significant differences(χ^(2)=29.044,P<0.001). The ≥30% and <60% positive rates of Ki67 were 0.00%,75.00% and 12.50%,and the ≥ 60% positive rates were 0.00%,0.00% and 87.50%. There were statistically significant differences(χ^(2)=73.853,P<0.001). The recurrence rate of benign phyllodes tumor was 0.00%(0/26),borderline was 6.25%(1/16),and malignant was 12.50%(1/8). Pearson correlation analysis showed that the expression of Ki67 was positively correlated with recurrence rate in phyllodes tumors(r=0.871,P=0.032),the expression of CD34 and BCL2 were negatively correlated with recurrence rate(r=-1.000,P<0.001),and the expression of CD117 was not correlated with recurrence rate(r=0.723,P=0.482). Conclusion CD34,CD117,BCL-2,Ki67 combined immunohistochemistry has certain value in the diagnosis and prognosis of breast phyllodes tumors,especially for minimally invasive specimens or puncture specimens,which can guide clinical diagnosis and treatment.