免疫组织化学在恶性间皮瘤与肺腺癌鉴别诊断中的应用：对新型抗体的批判性评估
Immunohistochemistry in the distinction between malignant mesothelioma and pulmonary adenocarcinoma: a critical evaluation of new antibodies.
作者信息
Abutaily A S, Addis B J, Roche W R
机构信息
Respiratory Cell and Molecular Biology, University of Southampton, University of Southampton, Southampton General Hospital, UK.
出版信息
J Clin Pathol. 2002 Sep;55(9):662-8. doi: 10.1136/jcp.55.9.662.
AIM
The value of immunohistochemical staining in differentiating between malignant mesothelioma and pulmonary adenocarcinoma was re-examined using newly available commercial antibodies, with the aim of increasing the sensitivity and specificity of diagnosis, and simplifying the antibody panel required.
METHODS
Forty one malignant mesotheliomas and 35 lung adenocarcinomas were studied. Commercial antibodies to calretinin, E-cadherin, N-cadherin, surfactant apoprotein A (SP-A), thyroid transcription factor 1 (TTF-1), thrombomodulin, and cytokeratin 5/6 were applied using the streptavidin-biotin-peroxidase complex procedure on formalin fixed, paraffin wax embedded tissue.
RESULTS
E-cadherin was expressed in all adenocarcinomas and in 22% of the mesotheliomas. TTF-1 expression was detected in 69% of the adenocarcinomas and none of the mesotheliomas. Positive staining with polyclonal anticalretinin was detected in 80% of the mesotheliomas and 6% of the adenocarcinomas. N-cadherin was expressed in 78% of mesotheliomas and 26% of adenocarcinomas. Thrombomodulin was expressed in 6% of the adenocarcinomas and in 53% of the mesotheliomas. Cytokeratin 5/6 expression was detected in 6% of the adenocarcinomas and 63% of the mesotheliomas. The results were compared with the standard laboratory panel for mesothelioma diagnosis: anticarcinoembryonic antigen (anti-CEA), LeuM1, BerEP4, and HBME-1.
CONCLUSION
Of the antibodies used in this study, E-cadherin was 100% sensitive for pulmonary adenocarcinoma and TTF-1 was 100% specific for pulmonary adenocarcinoma. The application of these two antibodies alone was adequate for the diagnosis of 69% of adenocarcinomas and 78% of mesotheliomas. Where TTF-1 is negative and E-cadherin is positive, a secondary panel of antibodies, including BerEP4 and LeuM1 (CD15) and antibodies directed against CEA, calretinin, cytokeratin 5/6, thrombomodulin, and N-cadherin, is required for differentiation between malignant mesothelioma and pulmonary adenocarcinoma.
目的
使用新获得的商用抗体重新审视免疫组织化学染色在鉴别恶性间皮瘤和肺腺癌中的价值，以提高诊断的敏感性和特异性，并简化所需的抗体组合。
方法
对41例恶性间皮瘤和35例肺腺癌进行研究。采用链霉亲和素-生物素-过氧化物酶复合物法，将抗钙视网膜蛋白、E-钙黏蛋白、N-钙黏蛋白、表面活性蛋白A（SP-A）、甲状腺转录因子1（TTF-1）、血栓调节蛋白和细胞角蛋白5/6的商用抗体应用于福尔马林固定、石蜡包埋的组织。
结果
E-钙黏蛋白在所有腺癌和22%的间皮瘤中表达。TTF-1在69%的腺癌中检测到表达，而在间皮瘤中均未检测到。80%的间皮瘤和6%的腺癌检测到多克隆抗钙视网膜蛋白阳性染色。N-钙黏蛋白在78%的间皮瘤和26%的腺癌中表达。血栓调节蛋白在6%的腺癌和53%的间皮瘤中表达。细胞角蛋白5/6在6%的腺癌和63%的间皮瘤中检测到表达。将结果与间皮瘤诊断的标准实验室抗体组合（抗癌胚抗原（抗CEA）、LeuM1、BerEP4和HBME-1）进行比较。
结论
在本研究中使用的抗体中，E-钙黏蛋白对肺腺癌的敏感性为100%，TTF-1对肺腺癌的特异性为100%。单独应用这两种抗体足以诊断69%的腺癌和78%的间皮瘤。当TTF-1阴性且E-钙黏蛋白阳性时，需要一组包括BerEP4和LeuM1（CD15）以及针对CEA、钙视网膜蛋白、细胞角蛋白5/6、血栓调节蛋白和N-钙黏蛋白的抗体的二级抗体组合，以鉴别恶性间皮瘤和肺腺癌。
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