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目的:探讨胸腔镜胸膜活组织检查联合免疫组织化学(组化)在恶性胸腔间皮瘤临床诊断中的应用价值。方法:通过视频胸腔镜检查(video-assisted thoracoscopic surgery,VATS)进行胸膜取材活检确诊恶性胸腔间皮瘤79例为观察组,胸活确诊163例肺腺癌作为对照组,采用常规HE染色联合应用免疫组织化学SP法检测钙结合蛋白(calretinin),癌胚抗原(carcinoembryonic antigen,CEA),CD15,细胞角蛋白(cytokeratin,CK 5/6),E-钙黏着蛋白(E-cadherin)、上皮膜抗原(epithelial membrane antigen,EMA),间皮细胞蛋白(mesothelial cell,MC)、鼠源的单克隆抗体31(mouse monoclonal antibody31,Moc-31)、甲状腺转录因子1(thyroid transcription factor-1,TTF-1)、血栓调节蛋白(thrombomodulin)、波形蛋白(vimentin)、肾母细胞瘤1蛋白(Wilms’tumor 1,WT-1)的表达并进行统计学分析。结果:观察组79例恶性胸膜间皮瘤中,上皮型48例、双相型22例、肉瘤样型9例。恶性胸膜间皮瘤和肺腺癌的免疫表型分析,间皮细胞相关抗体calretinin,WT-l,CK5/6和MC的表达在观察组和对照组间差异有统计学意义(P<0.01);CEA,CD15,E-cadherin,MOC-31,TTF-1,vimentin及thrombomodulin的表达在两组间差异也有统计学意义(P<0.01);而EMA的表达在两组间差异无统计学意义(P>0.05)。对免疫组织化学染色结果采用logistic回归分析,结果显示进入回归方程的自变量是E-cadherin和TTF-1(P<0.01)。结论:VATS胸膜活组织检查联合免疫组化检查,能提高恶性胸腔间皮瘤诊断的准确性,E-cadherin和TTF-1阴性是发生恶性胸腔间皮瘤的危险因素,阳性时多发肺腺癌。
Objective: To investigate the value of thoracoscopic pleural biopsy combined with immunohistochemistry (IHC) in the clinical diagnosis of malignant pleural mesothelioma. Methods: 79 cases of malignant thoracic mesothelioma confirmed by pleural biopsy under video-assisted thoracoscopic surgery (VATS) were selected as the observation group and 163 cases of lung adenocarcinoma as the control group were treated by routine HE staining Immunohistochemical SP method was used to detect the expressions of calretinin, carcinoembryonic antigen (CEA), CD15, cytokeratin (CK 5/6), E-cadherin, (EMA), mesothelial cell (MC), murine monoclonal antibody31 (Moc-31), thyroid transcription factor-1 (TTF- 1), thrombomodulin, vimentin, Wilms’tumor 1 (WT-1) were determined and statistically analyzed. Results: In 79 cases of malignant pleural mesothelioma in the observation group, 48 cases were epithelial type, 22 cases were bipolar type and 9 cases were sarcomatoid type. The immunophenotype analysis of malignant pleural mesothelioma and lung adenocarcinoma showed that the expression of calretinin, WT-1, CK5 / 6 and MC in mesothelial cells was significantly different between observation group and control group (P <0.01) ; The expression of CEA, CD15, E-cadherin, MOC-31, TTF-1, vimentin and thrombomodulin were also significantly different between the two groups (P <0.01); while the expression of EMA was not significantly different between the two groups (P> 0.05). Logistic regression analysis of immunohistochemical staining results showed that the independent variables that entered the regression equation were E-cadherin and TTF-1 (P <0.01). Conclusions: VATS pleural biopsy combined with immunohistochemistry can improve the diagnostic accuracy of malignant pleural mesothelioma. E-cadherin and TTF-1 negative are the risk factors of malignant pleural mesothelioma. Positive pulmonary adenocarcinoma .