CK5/6、p63在乳腺良恶性病变鉴别诊断中的意义

目的:探讨CK5/6、p63标记在乳腺良恶性疾病中的表达及意义。方法:根据WHO(2003)乳腺肿瘤分类标准收集乳腺普通型增生(UDH),非典型增生(ADH),原位癌(DC IS)和浸润性导管癌(IDC)标本各12例。应用免疫组化进行CK5/6、p63检测,观察其在不同类型病变乳腺组织中的分布及表达水平。结果:在UDH中,CK5/6阳性的细胞主要分布于肌上皮和腔内的腺上皮,腺腔中的阳性细胞排列呈马赛克状;p63主要表达于导管周围的肌上皮;两种标志物均呈中-重度阳性着色。在ADH中,CK5/6阳性细胞主要分布于肌上皮,腺腔内仅见少许腺上皮呈阳性着色;p63主要表达于导管周围的肌上皮;相比UDH而言,CK5/6和p63的阳性表达率明显减低。在DC IS中,肌上皮CK5/6仅呈轻-中度阳性着色,而腺腔内腺上皮未见明显着色,p63主要表达于导管周围的肌上皮。与ADH相比而言,CK5/6的表达水平明显减低,但p63的阳性表达率未见明显变化。在IDC中,仅1例肿瘤细胞CK5/6呈阳性着色,另外1例肿瘤间质中可见少许p63阳性表达细胞。结论:联合运用CK5/6、p63可鉴别UDH,ADH,DC IS和IDC。

Significance of CK5/6 and p63 in the differential diagnosis of benign and malignant breast lesions

Objective To investigate the significance of breast myoepithelial cell markers CK5/6 and p63 in the differential diagnosis of benign and malignant breast lesions.Method Forty-eight breast cases,including usual duct hyperplasia（UDH,n=12）,atypical duct hyperplasia（ADH,n=12）,duct in situ carcinoma（DCIS,n=12） and invasive duct carcinoma（IDC,n=12）,were obtained from our department according to the WHO classification of the breast cancer（2003）.The immunohistochemical method was performed to detect expressions of CK5/6 and p63.Results In UDH,the expression of CK5/6 and p63 was mainly located in the myoepithelial cells surrounding the glands.Meanwhile,focal positive staining for CK5/6 was seen in gland cells in all cases and appeared the mosaic pattern in gland.In ADH,the distribution of positive cells for CK5/6 and p63 was similar to that of UDH.In contrast to UHD,the positive rate for CK5/6 and p63 was significantly decreased in ADH.In DCIS,the distribution of positive cells for CK5/6 and p63 was mainly located in myoepithelial cells,but no positive cells for CK5/6 were observed in gland cells.The expression of CK5/6 in DCIS was significantly less than that in ADH.But,there had no significant difference for the expression of p63 between ADH and DCIS.In IDC,focal positive cells for CK5/6 was seen in one case.Only one case showed a few of positive cells for p63 staining.Conclusion A panel of myoepithelial markers,including CD5/6 and p63,can be used to differentiate the UDH,ADH,DCIS and IDC.