Gui Shuyu, Liu Hu, Zhang Lin, Zuo Li, Zhou Qing, Fei Guanghe, Wang Yuan
Laboratory of Molecular Biology, Anhui Medical University, PR China.
Intern Med. 2007;46(15):1161-6. doi: 10.2169/internalmedicine.46.6204. Epub 2007 Aug 2.
To assess the role of the p16 gene exon 2 homozygous deletion in malignant pleural effusions.
The homozygous deletion of p16 gene was determined in 34 pleural effusions due to non-small cell lung cancer (NSCLC) and in 21 cases with tuberculous pleuritis by polymerase chain reaction (PCR), compared with the determination of exfoliated cytology in the same specimens.
The PCR analysis showed that the homozygous deletion of p16 exon 2 was identified in 15 of 34 malignant pleural effusions (44.11%), including 8 negative cytology and it was not found any tuberculous pleural effusions. The exfoliated cytology of pleural effusion was positive in 19 of 34 malignant cases (55.88%). By combining two methods, the diagnostic sensitivity was enhanced, from 55.88% (19/34) to 79.41% (27/34), whose positive rate was higher than only determination of p16 exon2 homozygous deletion or exfoliated cytology in malignant pleural effusions (p<0.001, p<0.05 respectively).
Our data suggested that combining the examination of exfoliated cytology and homozygous deletion of p16 gene exon2 in pleural effusion can recruit and enhance the diagnostic value of pleural effusion cytology. The detection of the homozygous deletion of the p16 gene in pleural effusion may be a useful adjunct to the cytological and histological examinations of pleural effusion. In cases of undiagnosed exudative pleural effusion with a high clinical suspicion for malignancy, it is reasonable to examine the homozygous deletion of pleural fluid p16 gene. With p16 gene homozygous deletion in pleural effusion, it may be strongly highly likely to be malignant and have a higher metastatic potential.
评估p16基因外显子2纯合缺失在恶性胸腔积液中的作用。
采用聚合酶链反应（PCR）检测34例非小细胞肺癌（NSCLC）所致胸腔积液及21例结核性胸膜炎患者胸腔积液中p16基因的纯合缺失情况，并与同一标本的脱落细胞学检查结果进行比较。
PCR分析显示，34例恶性胸腔积液中有15例（44.11%）检测到p16外显子2纯合缺失，其中8例细胞学检查为阴性，结核性胸腔积液中未发现p16外显子2纯合缺失。34例恶性胸腔积液中19例（55.88%）脱落细胞学检查阳性。两种方法联合应用可提高诊断敏感性，从55.88%（19/34）提高到79.41%（27/34），联合检测的阳性率高于单纯检测p16外显子2纯合缺失或脱落细胞学检查在恶性胸腔积液中的阳性率（分别为p<0.001，p<0.05）。
本研究数据提示，胸腔积液脱落细胞学检查与p16基因外显子2纯合缺失检测相结合可提高胸腔积液细胞学检查的诊断价值。胸腔积液中p16基因纯合缺失的检测可能是胸腔积液细胞学和组织学检查的有用辅助手段。对于临床高度怀疑为恶性的不明原因渗出性胸腔积液，检测胸腔积液p16基因纯合缺失是合理的。胸腔积液中存在p16基因纯合缺失时，很可能为恶性且具有较高的转移潜能。
