Department of Pathology, National Hospital Organization Nagoya Medical Center, Aichi, Japan.
Virchows Arch. 2011 May;458(5):547-59. doi: 10.1007/s00428-011-1065-2. Epub 2011 Mar 25.
To determine whether the measurement of biomarkers in the needle washout fluid after fine needle aspiration cytology could strengthen cytological diagnosis, 29 benign lesions, 26 ductal carcinomas in situ (DCIS), and 95 invasive carcinomas of the breast were analyzed. Immediately after the aspiration samples were expelled onto glass slides, the needle was rinsed out with 2 ml of saline. Human epidermal growth factor receptor two extracellular domain (HER2-ECD) and cancer antigen 15-3 (CA 15-3) in the washout fluid were measured using chemiluminescence. The measuring limit for HER2-ECD (0.5 ng/ml) and that for CA 15-3 (4 U/ml) were used as the cutoff values, respectively. The proportion of patients with positive HER2-ECD values was 6.9% in cases of benign lesions, 26.9% in DCIS, and 10.5% in invasive carcinomas. The proportion of patients with positive CA 15-3 values was 6.9% in cases of benign lesions, 42.3% in DCIS, and 10.5% in invasive carcinomas. The proportion of patients with any biomarker elevation was 6.9% in cases of benign lesions, 46.2% in DCIS, and 15.8% in invasive carcinomas. Thus, biomarker elevation was most frequent in cases of DCIS, followed by invasive carcinomas (P < 0.01). HER2-ECD values over 6 ng/ml or CA 15-3 values over 25 U/ml were seen exclusively in cases of DCIS or invasive ductal carcinomas with an extensive intraductal component. If the biomarker status is included, 5 of 12 cases of DCIS with equivocal cytology categories would be upgraded. Further clinicopathological validation is necessary before applying this new approach to the clinical setting.
为了确定细针抽吸细胞学后针吸冲洗液中生物标志物的测量是否可以增强细胞学诊断，分析了 29 个良性病变、26 个导管原位癌（DCIS）和 95 个乳腺浸润性癌。抽吸样本立即被排出到载玻片上后，用 2ml 生理盐水冲洗针。用化学发光法测量冲洗液中的人表皮生长因子受体 2 细胞外结构域（HER2-ECD）和癌抗原 15-3（CA 15-3）。HER2-ECD 的测量限值（0.5ng/ml）和 CA 15-3 的测量限值（4U/ml）分别用作截断值。HER2-ECD 阳性的患者比例分别为良性病变 6.9%、DCIS 26.9%和浸润性癌 10.5%。CA 15-3 阳性的患者比例分别为良性病变 6.9%、DCIS 42.3%和浸润性癌 10.5%。任何生物标志物升高的患者比例分别为良性病变 6.9%、DCIS 46.2%和浸润性癌 15.8%。因此，标志物升高在 DCIS 中最常见，其次是浸润性癌（P<0.01）。HER2-ECD 值超过 6ng/ml 或 CA 15-3 值超过 25U/ml 仅见于 DCIS 或具有广泛导管内成分的浸润性导管癌。如果包括生物标志物状态，则 12 例细胞学分类不确定的 DCIS 中有 5 例将升级。在将这种新方法应用于临床环境之前，需要进一步进行临床病理验证。
