胸腔积液中腺癌细胞甲状腺转录因子1表达的定量研究.DOCVIP

临床医学论文-胸腔积液中腺癌细胞甲状腺转录因子1表达的定量研究 【摘要】? 目的 分析甲状腺转录因子1(TTF1)在胸腔积液腺癌细胞中的表达特点及规律，从量化角度探讨其作为判断胸水中转移性肺腺癌组织来源指标的临床应用价值。方法 选用胸腔积液转移性腺癌48例，其中肺源性腺癌37例，非肺源性腺癌11例。每例均制备巴氏染色细胞涂片和离心沉淀石蜡包埋细胞蜡块切片，并对相应细胞蜡块切片行HE染色和TTF1免疫组织化学染色。结果 37例肺腺癌中28例表达TTF1，11例肺外腺癌无1例表达TTF1。胸水中肺源性腺癌细胞与非肺源性腺癌细胞TTF1 PU值的比较差异具有显著性（p0.01）。定量结果显示胸水中肺源性腺癌细胞与非肺源性腺癌细胞TTF1 PU值的频数分布无重叠，以PU值大于8作为判断肺源性腺癌细胞的诊断阈值，以PU值小于6作为判断非肺源性腺癌细胞的诊断阈值，其诊断试验评价结果显示TTF1对癌性胸水中肺腺癌细胞诊断的灵敏度为75.7%，特异度为100%。标准化阳性预告值为100％，标准化阴性预告值为80.43％，标准化准确度为87.84％。结论 在排除甲状腺癌的可能性后，TTF1作为胸腔积液细胞蜡块标本肺腺癌细胞的诊断性标志具有较高的特异性和敏感性，胸水中腺癌细胞TTF1的PU值可作为判断肺源性与非肺源性腺癌细胞的特异性诊断指标。 【关键词】? 胸腔积液； 甲状腺转录因子1； 肺腺癌； 免疫组织化学； 定量分析 ??? Abstract: Objective? To explore the clinic value of thyroid transcription factor1(TTF1) as a marker for matastatic adenocarcinoma of lung origin by quantitative analysis of TTF1 in adenocarcinoma cells of pleural effusion. Methods? A total of? 48 cases of malignant pleural matastatic adenocarcinoma usesd in this experiment, which were 37 adenocarcinomas from lung and 11 adenocarcinomas of extrapulmonary were diagnosed clinically or histologically. Pap stained smear and cell block were prepared from pleural effusion speciments of these cases and immunohistochemical detection of TTF1 was performed on the cell block sections. Results? TTF1 was expressed in 28 lung adenocarcinomas while? none of? the 11extrapulmonary adenocarcinomas expressed TTF1. TTF1 positive unit(PU) is bigger in lung adenocarcinomas than in those of extrapulmonary adenocarcinomas and there is a significant difference between them（p0.01）. Conclusions? It was suggested that the TTF1 positive unit(PU) in pleural effusion might be valuable marker in diagnosis of adenocarcinoma cells in malignant pleural effusions come from lung if the thyroid carcinoma could be excluded. ??? Key words: pleural effusion; thyroid transcription factor1; lung adenocarcinoma; immunohistochemistry； quantitative study ??? 胸腔积液中最常见的恶性肿瘤细胞是转移性腺癌细胞。肺腺癌、乳腺癌、胃癌、卵巢癌等的癌细胞通过转移均可出现在胸腔积液中，以肺腺癌最为常见［1］。不少恶性肿瘤患者以