Nagel H, Schlott T, Schulz G M, Droese M
Department of Cytopathology, Georg August University of Göttingen, Germany.
Diagn Mol Pathol. 2001 Mar;10(1):60-5. doi: 10.1097/00019606-200103000-00010.
Diagnostic accuracy in effusion cytology based on morphologic examination is not always satisfactory. Therefore, various diagnostic adjuncts such as immunocytochemistry or deoxyribonucleic acid cytometry are employed in this diagnostic field. Recently, demonstration of telomerase activity has been proposed as a possible marker for malignancy. In this study a seminested reverse transcription-polymerase chain reaction (RT-PCR) strategy for expression analysis of the catalytic subunit of human telomerase (hEST2) was used in 58 serous effusions. RT-PCR results correlated with cytologic diagnoses in 14 of 17 malignant effusions. In eight effusions cytologically suspicious for malignancy, PCR results were in accordance with the clinical follow-up. However, hEST2 RT-PCR was also positive in six of 15 cytologically benign effusions that consisted predominantly of inflammatory and mesothelial cells. Using the telomeric repeat amplification protocol, it could be demonstrated that cultured, proliferating benign mesothelial cells may present a weak telomerase activity, as is known in other benign cells including activated lymphocytes. In conclusion, the simple and rapid method of hEST2 RT-PCR serves to support the cytologic diagnosis of malignancy, but false-positive PCR results resulting from activated lymphocytes and proliferating mesothelial cells must be considered.
基于形态学检查的积液细胞学诊断准确性并不总是令人满意。因此，在这个诊断领域采用了各种诊断辅助手段，如免疫细胞化学或脱氧核糖核酸细胞计数法。最近，端粒酶活性的检测已被提议作为恶性肿瘤的一种可能标志物。在本研究中，一种用于人端粒酶催化亚基（hEST2）表达分析的半巢式逆转录-聚合酶链反应（RT-PCR）策略被应用于58例浆液性积液。RT-PCR结果与17例恶性积液中的14例细胞学诊断相关。在8例细胞学上怀疑为恶性的积液中，PCR结果与临床随访一致。然而，在15例主要由炎症细胞和间皮细胞组成的细胞学良性积液中，有6例hEST2 RT-PCR也呈阳性。使用端粒重复序列扩增法可以证明，培养的、增殖的良性间皮细胞可能呈现出微弱的端粒酶活性，这在包括活化淋巴细胞在内的其他良性细胞中是已知的。总之，hEST2 RT-PCR这种简单快速的方法有助于支持恶性肿瘤的细胞学诊断，但必须考虑到由活化淋巴细胞和增殖间皮细胞导致的假阳性PCR结果。
