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目的探讨高分子量角蛋白CK34βE12、间皮细胞(MC)表达和BRAF基因突变在甲状腺乳头状癌(PTC)中的临床意义。方法采用免疫组化Envision两步法检测88例PTC和88例甲状腺良性病变(BTL)中CK34βE12、MC的表达;采用PCR及DNA测序法检测36例PTC和36例BTL中BRAF基因突变状况,分析其与PTC临床病理特征的关系。结果 88例PTC组织中CK34βE12、MC阳性率分别为96.6%、95.5%,高于BTL组织中的13.6%、6.8%(P<0.05)。CK34βE12、MC在PTC组织中表达的敏感性分别为96.6%、95.5%,特异性分别为86.4%、93.2%。36例PTC组织中BRAF突变率为63.9%,高于BTL组织中的0.0%(P<0.05)。BRAF突变与肿瘤淋巴结转移密切相关(P<0.05)。结论检测CK34βE12、MC在PTC与BTL鉴别诊断中具有重要实用价值;BRAF突变对确诊PTC具有重要临床意义,且可能是预测PTC侵袭转移能力的指标。
Objective To investigate the clinical significance of high molecular weight keratinocytes (CK34βE12), mesothelial cells (MC) and BRAF gene mutation in papillary thyroid carcinoma (PTC). Methods The expression of CK34βE12 and MC in 88 cases of PTC and 88 cases of benign thyroid lesions (BTL) were detected by immunohistochemical Envision two-step method. The mutation status of BRAF gene in 36 cases of PTC and 36 cases of BTL was detected by PCR and DNA sequencing. Its relationship with the clinicopathological features of PTC. Results The positive rates of CK34βE12 and MC in 88 cases of PTC were 96.6% and 95.5%, respectively, which were higher than those in BTL tissues (13.6% and 6.8%, P <0.05). The sensitivity of CK34βE12 and MC in PTC tissues were 96.6% and 95.5%, respectively, and the specificity was 86.4% and 93.2% respectively. The mutation rate of BRAF in 36 cases of PTC was 63.9%, which was higher than that of 0.0% in BTL (P <0.05). The mutation of BRAF is closely related to tumor lymph node metastasis (P <0.05). Conclusion Detection of CK34βE12 and MC is of great practical value in the differential diagnosis of PTC and BTL. The mutation of BRAF is of great clinical significance for the diagnosis of PTC, and may be an index to predict the invasion and metastasis of PTC.