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目的探讨组合性抗体在乳腺癌继发肺内腺癌患者病理学诊断和鉴别诊断中的应用价值。方法采用免疫组化法检测39例乳腺癌继发肺癌患者标本中乳腺珠蛋白(MGB1)等8种抗体的表达,另选266例已确诊的其他部位腺癌及肺内转移性腺癌为对照,评价其鉴别肺内转移性乳腺癌的特异性、敏感性和阳性预测值。结果天冬氨酸蛋白酶(Napsin A)、肺泡表面活性蛋白A和B(SP-A和SP-B)在肺癌中的阳性率分别为84.2%、78.9%和42.1%,而在乳腺、胃肠道、肝胆胰、子宫及卵巢腺癌和肺内非乳腺来源的转移性腺癌中呈阴性表达;甲状腺转录因子(TTF-1)在肺癌中阳性率为86.8%,在乳腺癌中呈阴性表达。乳腺珠蛋白(MGB1)、大囊泡病液体蛋白-15(GCDFP-15)在乳腺癌中阳性率分别为62.9%和42.9%,在肺癌中呈阴性表达,并且显著高于其他部位腺癌(P<0.05);雌激素受体(ER)和孕激素受体(PR)在乳腺癌(88.6%和71.4%)表达显著高于肺癌(2.6%和2.6%)。将TTF-1、NapsinA、SP-A、SP-B、MGB1、GCDFP-15、ER和PR抗体组合检测39例乳腺癌继发肺癌患者,其鉴别肺内转移性乳腺癌的敏感度为87.5%,特异度为71.4%,阳性预测值为93.3%。结论组合性抗体TTF-1、NapsinA、SP-A、SP-B、MGB1、GCDFP-15、ER和PR有助于准确鉴别乳腺癌患者继发肺癌是转移性乳腺癌或肺原发癌,可为这类患者的临床分期和个体化治疗提供准确的科学依据。
Objective To investigate the value of combinatorial antibodies in the pathological diagnosis and differential diagnosis of patients with secondary adenocarcinoma of the breast. Methods Immunohistochemical method was used to detect the expression of 8 kinds of antibodies such as MGB1 in 39 specimens of breast cancer patients with secondary lung cancer. The other 266 cases of confirmed adenocarcinoma and metastatic adenocarcinoma of the lung were selected as the control. To evaluate the specificity, sensitivity and positive predictive value of identifying metastatic breast cancer in the lung. Results The positive rates of Napsin A, alveolar surfactant A and B (SP-A and SP-B) in lung cancer were 84.2%, 78.9% and 42.1% The positive rate of thyroid transcription factor (TTF-1) in lung cancer was 86.8%, which was negative in breast cancer. The positive rate of TTF-1 in lung, gallstone pancreatic, uterine and ovarian adenocarcinoma and non-breast metastatic lung adenocarcinoma was negative. The positive rates of MGB1 and GCDFP-15 in breast cancer were 62.9% and 42.9%, respectively, which were negative in lung cancer and significantly higher than those in other parts of adenocarcinoma P <0.05). The expression of estrogen receptor (ER) and progesterone receptor (PR) in breast cancer (88.6% vs 71.4%) was significantly higher than that in lung cancer (2.6% vs 2.6%). The detection of 39 breast cancer patients with secondary lung cancer by TTF-1, NapsinA, SP-A, SP-B, MGB1, GCDFP-15, ER and PR antibodies was 87.5% , Specificity was 71.4%, positive predictive value was 93.3%. Conclusion The combination of antibodies TTF-1, Napsin A, SP-A, SP-B, MGB1, GCDFP-15, ER and PR can help to accurately identify secondary breast cancer in patients with breast cancer as metastatic breast cancer or primary lung cancer. For these patients clinical staging and individualized treatment to provide accurate scientific basis.