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目的评价免疫组织化学染色和 SYT-SSX 融合基因检测在滑膜肉瘤诊断中的价值与应用范围。方法收集可能为滑膜肉瘤的病例195例,根据临床表现、组织学形态和免疫组织化学染色结果将其分成确诊、高度可疑和可疑滑膜肉瘤,利用逆转录-聚合酶链反应(RT-PCR)技术检测石蜡包埋组织中 SYT-SSX 融合基因的表达,并比较其与免疫组织化学 PV6000二步法染色之间的关系,评价各自的诊断价值。结果确诊、高度可疑和可疑滑膜肉瘤分别为62(31.8%)、49(25.1%)和84例(43.1%)。179例(91.8%)样本能够进行 SYT-SSX 的 RT-PCR 检测,其中140例(78.2%)呈阳性。SYT-SSX 在确诊、高度可疑和可疑病例中的阳性率分别为94.7%(54/57)、86.0%(37/43)和62.0%(49/79)。上皮膜抗原(EMA)在确诊和高度可疑滑膜肉瘤 SYT-SSX 阳性病例中的阳性率明显高于其SYT-SSX 阴性病例(分别 P=0.022,P=0.010),且 EMA 与 SYT-SSX 表达呈正相关(分别 r_s=0.431,P=0.001;r_s=0.463,P=0.002),而细胞角蛋白、波形蛋白和 S-100蛋白在两类病例中的阳性率差异无统计学意义(P>0.05);4种指标在可疑滑膜肉瘤 SYT-SSX 阳性和阴性病例中的表达差异无统计学意义(P>0.05)。结论利用传统诊断方法可以确诊的滑膜肉瘤不必进行 SYT-SSX 检测;EMA 免疫组织化学染色在高度可疑滑膜肉瘤中的诊断价值与 SYT-SSX 的 RT-PCR 检测相近,可以代替后者;但是,融合基因的 RT-PCR 分析对可疑滑膜肉瘤的确诊具有重要意义。
Objective To evaluate the value and application of immunohistochemical staining and SYT-SSX fusion gene in the diagnosis of synovial sarcoma. Methods A total of 195 cases of synovial sarcoma were collected. According to their clinical manifestations, histological features and immunohistochemical staining results, they were divided into four groups, which were diagnosed, highly suspicious and suspicious. The synovial sarcoma was detected by reverse transcription polymerase chain reaction ) Technique was used to detect the expression of SYT-SSX fusion gene in paraffin-embedded tissues and their relationship with PV6000 two-step immunohistochemical staining was evaluated. RESULTS: Highly suspicious and suspicious synovial sarcomas were 62 (31.8%), 49 (25.1%) and 84 (43.1%), respectively. 179 (91.8%) samples were able to perform RT-PCR for SYT-SSX, of which 140 (78.2%) were positive. The positive rates of SYT-SSX in diagnosed, highly-suspicious and suspicious cases were 94.7% (54/57), 86.0% (37/43) and 62.0% (49/79), respectively. The positive rate of epithelial membrane antigen (EMA) in SYT-SSX positive cases with confirmed and highly suspected synovial sarcoma was significantly higher than that in SYT-SSX negative cases (P = 0.022, P = 0.010, respectively) (R_s = 0.431, P = 0.001; r_s = 0.463, P = 0.002). There was no significant difference in the positive rates of cytokeratin, vimentin and S-100 between the two groups (P> 0.05 ). There was no significant difference in the expression of four indexes between SYT-SSX positive and negative cases of suspicious synovial sarcoma (P> 0.05). Conclusion SYT-SSX detection is not necessary for synovial sarcoma that can be diagnosed by traditional diagnostic methods. The diagnostic value of EMA immunohistochemical staining in highly suspicious synovial sarcoma is similar to RT-PCR detection of SYT-SSX, , RT-PCR analysis of fusion gene is of great significance for the diagnosis of suspicious synovial sarcoma.