层粘连蛋白-5免疫细胞化学：一种用于识别口腔刷检活检中发育异常细胞的新工具。

Laminin-5 immunocytochemistry: a new tool for identifying dysplastic cells in oral brush biopsies.

作者信息

Driemel O, Dahse R, Hakim S G, Tsioutsias T, Pistner H, Reichert T E, Kosmehl H

机构信息

Department of Oral and Maxillofacial Surgery, University of Regensburg, Regensburg, Germany.

出版信息

Cytopathology. 2007 Dec;18(6):348-55. doi: 10.1111/j.1365-2303.2006.00401.x.

DOI:10.1111/j.1365-2303.2006.00401.x

PMID:18031447

Abstract

BACKGROUND

The brush biopsy technique is not only a seminal technique but also a critically discussed method for detection of oral pre-cancerous stages and manifest carcinomas. The gamma2 chain of laminin-5 and its proteolytic fragments comprise an invasion factor for many carcinomas.

OBJECTIVES

The aim of this study was to determine whether the immunocytochemical presentation of the laminin gamma2 chain identifies pre-invasive or invasive squamous cells in brush biopsies.

METHODS

The value-based identification of atypical epithelia was analysed in 93 consecutive brush biopsies with histopathological diagnoses: standardized haematoxylin and eosin staining; standardized immunocytochemistry: monoclonal antibodies against laminin gamma2 chain: D4B5, 4G1, detection using ChemMate and Autostainer.

RESULTS

Conventional cytology did not result in any false-positive cases, i.e. atypical cells in normal, inflamed or benignly hyperproliferative mucosa (specificity, 100%), whereas immunocytochemistry revealed one false-positive case (specificity, 98%). In brush biopsies of oral squamous cell carcinomas, the following immunocytochemical patterns were possible: (1) staining of the cytoplasm, (2) banded markings between clumped carcinoma cells and (3) positive hazes surrounding atypical cells. Bacterial colonies appeared as false-positive results. Four of 27 carcinomas and one of three recurrences were not cytologically identified (sensitivity of conventional cytology, 79%). Three of the five carcinomas not identified by cytology were immunocytochemically stained with laminin gamma2 chain antibody (sensitivity of laminin gamma2 chain immunocytochemistry, 93%). The positive predictive value was 100% for conventional cytology and 97% for laminin gamma2 chain immunocytochemistry. The negative predictive value attained was 92% for conventional cytology and 97% for laminin gamma2 chain immunocytochemistry.

CONCLUSIONS

The high sensitivity level observed for method-enhanced brush cytology suggests that this technique be used as an initial diagnostic step.

摘要

背景

刷检活检技术不仅是一项开创性技术，也是检测口腔癌前阶段和显性癌的备受争议的方法。层粘连蛋白-5的γ2链及其蛋白水解片段是许多癌症的侵袭因子。

目的

本研究的目的是确定层粘连蛋白γ2链的免疫细胞化学表现是否能识别刷检活检中的侵袭前或侵袭性鳞状细胞。

方法

在93例连续的刷检活检中分析基于价值的非典型上皮细胞识别情况，这些活检具有组织病理学诊断：标准化苏木精和伊红染色；标准化免疫细胞化学：抗层粘连蛋白γ2链单克隆抗体：D4B5、4G1，使用ChemMate和自动染色仪进行检测。

结果

传统细胞学检查未出现假阳性病例，即在正常、炎症或良性增生性黏膜中未出现非典型细胞（特异性为100%），而免疫细胞化学检查发现1例假阳性病例（特异性为98%）。在口腔鳞状细胞癌的刷检活检中，可能出现以下免疫细胞化学模式：（1）细胞质染色，（2）聚集的癌细胞之间的带状标记，（3）非典型细胞周围的阳性晕圈。细菌菌落表现为假阳性结果。27例癌症中有4例以及3例复发病例中有1例未通过细胞学检查识别（传统细胞学检查的敏感性为79%）。5例未通过细胞学检查识别的癌症中有3例通过层粘连蛋白γ2链抗体进行了免疫细胞化学染色（层粘连蛋白γ2链免疫细胞化学检查的敏感性为93%）。传统细胞学检查的阳性预测值为100%，层粘连蛋白γ2链免疫细胞化学检查的阳性预测值为97%。传统细胞学检查的阴性预测值为92%，层粘连蛋白γ2链免疫细胞化学检查的阴性预测值为97%。