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目的探讨一组免疫组化标记物(p63、CK5/6、CK7、napsin A和TTF-1)在肺小活检中对鳞状细胞癌和腺癌的诊断与鉴别诊断意义。方法收集北京大学肿瘤医院83例肺原发性鳞状细胞癌和95例肺原发性腺癌的活检标本,应用免疫组化SP法检测p63、CK5/6、CK7、napsin A和TTF-1的表达。结果 p63和CK5/6在鳞状细胞癌中的阳性率分别为100%(83/83)和96%(80/83),特异性分别为80%和94%;CK7、napsin A和TTF-1在腺癌中的阳性率分别是94%(89/95)、71%(67/95)和87%(83/95),特异性分别是77%、100%和100%。结论对于肺鳞状细胞癌,p63的敏感性高于CK5/6,但p63的特异性差,在一部分腺癌中也有表达;对于肺腺癌,napsin A和TTF-1的特异性相同,但TTF-1的敏感性更高,尤其对于低分化腺癌,TTF-1是更好的免疫组化标记物;另外,CK7(+)更多见于腺癌,但是部分鳞状细胞癌也可以CK7(+)。因此,在非小细胞肺癌的小活检标本中,仅依靠形态学无法做出明确诊断时,鉴于没有任何一种标记物的敏感性和特异性均达到100%,故联合应用p63、CK5/6、CK7、napsin A和TTF-1能够提高敏感性和特异性。
Objective To investigate the diagnostic significance of a group of immunohistochemical markers (p63, CK5 / 6, CK7, napsin A and TTF-1) in the diagnosis of squamous cell carcinoma and adenocarcinoma in lung biopsy. Methods 83 cases of primary squamous cell carcinoma and 95 cases of primary pulmonary adenocarcinoma were collected from Peking University Cancer Hospital. Immunohistochemical SP method was used to detect the expression of p63, CK5 / 6, CK7, napsin A and TTF-1 expression. Results The positive rates of p63 and CK5 / 6 in squamous cell carcinoma were 100% (83/83) and 96% (80/83), respectively, with specificity of 80% and 94%, respectively. CK7, napsin A and TTF- 1 in adenocarcinoma was 94% (89/95), 71% (67/95) and 87% (83/95), respectively. The specificity was 77%, 100% and 100% respectively. Conclusions The sensitivity of p63 to lung squamous cell carcinoma is higher than that of CK5 / 6, but the specificity of p63 is poor and it is also expressed in some adenocarcinomas. For lung adenocarcinoma, napsin A and TTF-1 have the same specificity, but TTF -1 is more sensitive, especially for poorly differentiated adenocarcinoma, TTF-1 is a better immunohistochemical marker; In addition, CK7 (+) is more common in adenocarcinoma, but some squamous cell carcinoma can also CK7 ( +). Therefore, in the small biopsy specimens of non-small cell lung cancer, when the definite diagnosis can not be made only by morphology, since none of the markers have a 100% sensitivity and specificity, the combination of p63, CK5 / 6 , CK7, napsin A and TTF-1 increase sensitivity and specificity.