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目的:评估波形蛋白(VIM)、神经特异度钙结合蛋白(CR)、间皮细胞(MC),细胞角蛋白7(CK7)和甲状腺转录因子-1(TTF-1)免疫组化染色在转移性肺腺癌和恶性间皮瘤鉴别诊断中的价值。方法:收集经病理学确诊的恶性胸腔积液患者82例,选取其中的胸膜转移性肺腺癌和恶性胸膜间皮瘤患者纳入分析。评估TTF-1、CK7、Vimentin、MC和Cal-retinin 5项指标对胸膜转移性肺腺癌和恶性胸膜间皮瘤的诊断灵敏度和特异度。结果:VIM(χ2=4.99,P=0.014)、CR(χ2=23.74,P=0.01)和MC(χ2=13.08,P=0.001)的表达在恶性胸膜间皮瘤的表达高于胸膜转移性肺腺癌。而TTF-1(χ2=21.67,P<0.01)和CK7(χ2=18.12,P<0.01)在胸膜转移性肺腺癌表达高于恶性胸膜间皮瘤。对于恶性间皮瘤的诊断,VIM的灵敏度为72.7%(8/11),特异度为64.4%(29/45);CR的灵敏度为90.9%(10/11),特异度为84.4%(38/45);MC的灵敏度为72.7%(8/11),特异度为82.2%(37/45)。对于胸膜转移性肺腺癌的诊断,CK7的灵敏度为95.6%(43/45),特异度为54.5%(6/11);TTF-1的灵敏度为82.2%(37/45),特异度为90.9%(10/11)。结论:胸腔积液脱落细胞的TTF-1、CK7、Vimentin、MC和Calretinin免疫组化染色对恶性胸膜间皮瘤和胸膜转移性肺腺癌的鉴别具有较高价值。
OBJECTIVE: To evaluate the role of VIM, CK, MC, CK7 and TTF-1 in metastasis The value of differential diagnosis of lung adenocarcinoma and malignant mesothelioma. Methods: Eighty-two patients with malignant pleural effusion diagnosed by pathology were collected and included in the analysis of patients with pleural metastatic lung adenocarcinoma and malignant pleural mesothelioma. To evaluate the diagnostic sensitivity and specificity of TTF-1, CK7, Vimentin, MC and Cal-retinin in the diagnosis of pleural metastatic lung adenocarcinoma and malignant pleural mesothelioma. Results The expressions of VIM (χ2 = 4.99, P = 0.014), CR (χ2 = 23.74, P = 0.01) and MC (χ2 = 13.08, P = 0.001) were higher in malignant pleural mesothelioma than those in pleural metastatic lung Adenocarcinoma The expression of TTF-1 (χ2 = 21.67, P <0.01) and CK7 (χ2 = 18.12, P <0.01) in pleural metastatic lung adenocarcinoma was higher than that in malignant pleural mesothelioma. For the diagnosis of malignant mesothelioma, the sensitivity and specificity of VIM were 72.7% (8/11) and 64.4% (29/45) respectively. The sensitivity and specificity of CR were 90.9% (10/11) and 84.4% (38/38) respectively / 45). The sensitivity of MC was 72.7% (8/11) and the specificity was 82.2% (37/45). For the diagnosis of pleural metastatic lung adenocarcinoma, the sensitivity of CK7 was 95.6% (43/45) and the specificity was 54.5% (6/11). The sensitivity of TTF-1 was 82.2% (37/45) and the specificity was 90.9% (10/11). Conclusion: Immunohistochemical staining of TTF-1, CK7, Vimentin, MC and Calretinin in pleural effusion cells is of high value for differential diagnosis of malignant pleural mesothelioma and pleural metastatic lung adenocarcinoma.