摘要
目的探讨液基薄层细胞检测（ThinPrep cytologic test, TCT）与免疫细胞化学（immunocytochemistry, ICC）相结合在经支气管镜超声引导针吸活检术（endobronchial ultrasoundguided transbronchial needle aspiration, EBUSTBNA）和纤维支气管镜（纤支镜）刷片细胞学肺癌分型诊断及鉴别诊断中的应用价值。方法收集上海交通大学附属胸科医院2012年1～7月经EBUSTBNA和纤支镜常规细胞学诊断为低分化肺癌标本132例，所有病例均具有明确的组织病理诊断；应用TCT技术和ICC法检测p63、CK5/6、CK7、TTF-1、Syn、CD56在肺癌中的表达。结果细胞形态学与ICC联合诊断肺低分化癌132例，其中鳞癌、腺癌和小细胞癌的分型诊断符合率分别为93.2%、90.0%和95.2%；细胞学未分类癌12例，其中鳞癌4例、腺癌5例、小细胞癌1例、类癌1例、淋巴瘤1例。p63诊断鳞癌的敏感性和特异性分别为96.6%和93.0%；CK5/6诊断鳞癌的敏感性和特异性分别为94.9%和74.6%；CK7诊断腺癌的敏感性和特异性分别为98.0%和66.3%；TTF-1诊断腺癌的敏感性和特异性分别为96.0%和76.3%；Syn诊断小细胞癌的敏感性和特异性分别为81.0%和94.5%；CD56诊断小细胞癌的敏感性和特异性分别为85.7%和84.4%。结论（1）TCT技术和ICC法相结合检测相关蛋白表达，可提高肺癌分型诊断的准确性，可成为EBUS-TBNA和纤支镜细胞学肺癌分型诊断及鉴别诊断的一种重要手段；对于不适合手术而需放、化疗的患者，通过EBUS-TBNA、纤支镜刷片细胞学检查明确肺癌的具体分型尤为重要。（2）常规细胞学诊断低分化肺癌，需进一步行ICC检查，以排除少见的肺部肿瘤或其它病变。
Purpose To explore the value of application of ThinPrep cytologic test （TCT） in combination with immunocytochemistry （ ICC ） in diagnosis and differential diagnosis of lung cancer subtypes by endobronchial ultrasound-guided transbronchial needle aspira- tion （EBUS-TBNA） and bronchofibroseope brush cytology. Method 132 cases of poorly differentiated lung cancers diagnosed by transbronchial needle aspiration and bronchofibroseopic brush cytology were collected from Jan 2012 to July 2012 in our hospital, with definite pathologic diagnosis. The expression of p63, CK5/6, CK7, TPF-1, Syn and CD56 in those samples was detected by TCT and ICC using corresponding antibodies. Results The accordance rate of cytology in combination with ICC in differential diagnosis for 132 cases of poorly differentiated lung cancers reached 93.2% for squamous cell carcinoma, 90. 0% for adenocarcinoma, and 95.2% for small cell lung carcinoma, respectively. Yet there were 12 cases of unclassified lung cancers in cytology, 4 of which were histopatho- logically diagnosed as squamous cell carcinoma, 5 adenocarcinoma, 1 small cell lung carcinoma, 1 carcinoid, and 1 lymphoma. The sensitivity and specificity of p63 were 96. 6% and 93.0% , and those of CK5/6 were 94. 9% and 74. 6% , respectively, in diagnosis of squamous cell carcinoma. The sensitivity and specificity of CK7 were 98.0% and 66.3% , and those of TTF-1 were 96. 0% and 76. 3% , respectively, in diagnosis of adenocarcinoma. The sensitivity and specificity of Syn were 81.0% and 94. 5% , and those of CD56 were 85.7% and 84. 4% , respectively, in diagnosis of small cell lung cancer. Conclusions （ 1 ） The combination of TCT and ICC detection associated protein markers improves the accurate diagnosis of lung cancer subtypes, and may become an important method in diagnosis and differential diagnosis of lung cancer subtypes by TBNA and bronchofibroseopie brush cytology. Especially, it is important for radiotherapic and chemotherapic patients who are not fit for operation to identify the subtypes of lung cancers through TBNA and bronchofibroscopic brush cytology. （2） Poorly differentiated lung cancers diagnosed by cytology need ICC to exclude a few rare lung tumors and other changes.
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2013年第8期871-875,共5页
Chinese Journal of Clinical and Experimental Pathology
基金
上海市胸科医院科技发展基金(YZ12-17)
关键词
肺肿瘤
免疫细胞化学
诊断
鉴别诊断
lung neoplasms
immunocytochemistry
diagnosis
differential diagnosis
