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目的探讨Ventana全自动免疫组化法检测不同标本肺腺癌间变性淋巴瘤激酶(ALK)蛋白表达的阳性率及一致性。方法收集606例肺腺癌标本,包括手术切除标本261例、小活检标本244例和胸水细胞块标本101例,采用Ventana全自动免疫组化染色仪、抗ALK兔单克隆抗体(D5F3)和超敏检测系统进行染色,检测ALK蛋白表达情况。结果 606例肺腺癌标本中,49例ALK(+),557例ALK(-),阳性率为8.1%。手术切除标本261例中20例(+),阳性率为7.7%;小活检标本244例中20例(+),阳性率为8.2%;胸水细胞块标本101例中9例(+),阳性率为8.9%;比较3种标本的ALK蛋白阳性率,差异不显著(P>0.05)。606例标本中,同一患者兼具手术标本及小活检标本46例,有2对标本ALK(+),其余标本均(-),检测结果完全一致;同一患者兼具小活检标本和胸水细胞块标本14例,小活检标本1例(+),胸水细胞块标本3例(+),2对标本检测ALK蛋白结果存在差异(14.3%,2/14)。结论 Ventana全自动免疫组化检测可以作为肺腺癌ALK蛋白阳性患者克唑替尼靶向治疗的诊断方法。手术切除标本、小活检标本和胸水细胞块标本均可作为检测ALK蛋白的样本。肺腺癌原发灶与转移灶ALK蛋白检测是否存在差异性表达,有待进一步研究。
Objective To investigate the positive rate and consistency of Ventana automatic immunohistochemistry in detecting the expression of ALK protein in different kinds of lung adenocarcinoma. Methods Totally 606 lung adenocarcinoma specimens were collected, including 261 specimens of resection, 244 specimens of small biopsy specimens and 101 specimens of pleural effusion. The samples were collected with Ventana automatic immunohistochemical staining instrument, anti-ALK rabbit monoclonal antibody (D5F3) Sensitive detection system for staining, detection of ALK protein expression. Results Among the 606 cases of lung adenocarcinoma, 49 ALK (+) and 557 ALK (-) were positive, with a positive rate of 8.1%. The positive rate was 7.7% in 261 cases of resection specimens and 20 cases (+) in 244 cases of small biopsy specimens, and the positive rate was 8.2% in 101 cases of pleural effusion specimens, and 9 cases (+) in 101 cases of pleural effusion specimens were positive The rate of ALK protein was 8.9%. There was no significant difference (P> 0.05) between the three samples. Of the 606 patients, the same patient had both surgical specimens and small biopsy specimens in 46 cases, with 2 specimens of ALK (+) and the remaining specimens (-) with identical results. The same patient also had both small biopsy specimens and pleural effusion There were 14 specimens (14.3%, 2/14), 1 specimen (+) of small biopsy specimen and 3 specimens of pleural effusion specimen (+). Conclusion Ventana automatic immunohistochemistry can be used as a diagnostic method for the targeted therapy of crizotinib in ALK protein positive patients with lung adenocarcinoma. Surgical resection specimens, small biopsy specimens and pleural fluid cell mass specimens can be used as ALK protein samples. Whether there is difference expression between primary lung cancer and ALK protein in metastatic lung cancer remains to be further studied.