Yan Jinhai, Wei Qingzhu, Jian Wenjing, Liu Jianghuan, Tang Hongping, Ge Juan, Zhou Jie, Zhao Tong
Department of Pathology, School of Basic Medical Science, Southern Medical University Guangzhou, China.
Department of Pathology, The Third Affiliated Hospital, Southern Medical University Guangzhou, China.
Int J Clin Exp Pathol. 2014 Aug 15;7(9):5810-8. eCollection 2014.
The utility of combination with CK5/6, IMP3 and TTF1 to differentiate among reactive mesothelial cells (RMs), metastatic adenocarcinoma of lung (LAC) and non-lung (NLAC) origin was investigated by using immunocytochemistry (ICC) and conventional PCR (C-PCR) in pleural effusion. A total of 108 cell blocks (32 RMs, 51 LAC and 25 NLAC were evaluated by ICC for CK5/6, IMP3 and TTF1 protein expression. In addition, we further performed C-PCR for amplification of CK5/6, IMP3 and TTF1 DNA from 28 specimens (9 MAC and 7 RMs, 6 LAC and 6 NLAC) for molecular diagnosis. CK5/6 staining was observed in the majority of reactive specimens (78.1%) and was rare in adenocarcinoma cells (14.5%), whereas the opposite was true for IMP3 and TTF1. We found a high frequency of TTF1 positivity (76.5%) in LAC, but not in NLAC (4.0%); while there was no significant difference of IMP3 expression in LAC (88.2%) and NLAC (88.0%). The 487 bp DNA fragments of IMP3 was expected to be amplified in 6/9 of adenocarcinoma cases showed negative in ICC; and the 394 bp DNA fragments of CK5/6 was also expected to be amplified in 4/7 of RMs cases showed negative in ICC. Consistent with ICC results, there was significant difference of TTF1 expression in the LAC and NLAC compared with IMP3 expression. The combination with CK5/6, IMP3 and TTF1 immunostaining appears to be useful to improve the accuracy of cytological diagnoses between RMs, metastatic adenocarcinoma of lung and non-lung origin in pleural effusion. In addition, C-PCR may act as a useful supplemental approach for ICC, especially negative cases in ICC for differential cytological diagnosis.
通过免疫细胞化学（ICC）和常规聚合酶链反应（C-PCR）对胸腔积液中反应性间皮细胞（RMs）、肺转移性腺癌（LAC）和非肺源性腺癌（NLAC）进行鉴别诊断时，研究联合使用细胞角蛋白5/6（CK5/6）、胰岛素样生长因子Ⅱ信使核糖核酸结合蛋白3（IMP3）和甲状腺转录因子1（TTF1）的效用。总共108个细胞块（32个RMs、51个LAC和25个NLAC）通过ICC评估CK5/6、IMP3和TTF1蛋白表达。此外，我们进一步对28个标本（9个MAC、7个RMs、6个LAC和6个NLAC）进行C-PCR，扩增CK5/6、IMP3和TTF1 DNA用于分子诊断。在大多数反应性标本（78.1%）中观察到CK5/6染色，而在腺癌细胞中少见（14.5%），而IMP3和TTF1情况则相反。我们发现LAC中TTF1阳性率较高（76.5%），而NLAC中则无（4.0%）；而IMP3在LAC（88.2%）和NLAC（88.0%）中的表达无显著差异。预期在ICC中呈阴性的6/9腺癌病例中可扩增出IMP3的487 bp DNA片段；在ICC中呈阴性的4/7 RMs病例中也预期可扩增出CK5/6的394 bp DNA片段。与ICC结果一致，与IMP3表达相比，LAC和NLAC中TTF1表达存在显著差异。联合使用CK5/6、IMP3和TTF1免疫染色似乎有助于提高胸腔积液中RMs、肺转移性腺癌和非肺源性腺癌的细胞学诊断准确性。此外，C-PCR可作为ICC的一种有用补充方法，尤其是ICC中用于鉴别细胞学诊断的阴性病例。
