乳腺癌细针穿刺标本中端粒酶活性的临床意义

目的　研究乳腺细针穿刺细胞标本中的端粒酶活性 ,探讨其在乳腺癌辅助诊断中的临床意义 ;研究端粒酶表达与PR、ER、PCNA、c erbB2及p5 3之间的可能关系。方法　采用PCR TRAP技术检测 99例乳腺细针穿刺标本中的端粒酶活性。采用免疫组化技术检测 35例乳腺癌组织标本中孕激素受体 (PR)、雌激素受体 (ER)、细胞增殖核抗原 (PCNA)、癌基因c erbB2及p5 3蛋白表达水平。结果　 83例乳腺癌标本 ,在 6 9例细胞学阳性标本中 6 1例端粒酶阳性 ,7例细胞学可疑标本中 5例端粒酶阳性 ,7例细胞学阴性标本中 4例端粒酶阳性 ,端粒酶敏感性为 84.3% (70 / 83) ,端粒酶活性检测和细胞学诊断总符合率为 77.1% (6 4/ 83) ;12例乳腺良性病变标本中 ,4例端粒酶阳性 ;4例乳腺炎标本均为阴性。端粒酶表达与乳腺癌组织学类型、淋巴结转移、肿瘤大小、临床分期无相关性 ,与PR、ER状态、PCNA、c erbB2 表达亦无相关性 ,但与p5 3蛋白表达水平呈负相关。结论　乳腺细针穿刺标本端粒酶活性检测在乳腺癌临床诊断中有辅助诊断价值 ;其与p5 3蛋白表达水平之间的关系有待进一步阐明。

Clinical implications of telomerase activity in breast cancer fine needle aspirates

Objective To study the telomerase activity in samples of breast fine needle aspirates, its clinical implications, and possible association with expression of PR, ER, PCNA, c erbB2 and p53.Methods Ninetynine fine needle aspirates from breast cancers in 83 patients, 12 from benign lesions and 4 from inflammation of the breast, were examined for telomerase activity by a PCR based telomere repeat amplification protocol (PCR TRAP). In 35 breast cancer tissue specimens, expression of PR, ER, PCNA, c erbB2 and p53 were examined by immunohistochemical staining.Results Among 83 fine needle aspirates from breast cancer, telomerase activity was detected in 61 of 69 cytology possitive specimens and in 5 of 7 cytology suspicious specimens and in 4 of 7 cytology negative specimens, with an overall positive rate of 84.3% (70/83). The concordance rate of telomerase detection and cytologic examination was 77.1% (64/83). Of 12 fine needle aspirates from patients with benign breast lesions, 4 were telomerase positive, but 4 aspirates from inflammed breast were all negative. Telomerase activity of breast cancer aspirates did not correlate with histologic type, lymph node status, tumor size and clinical stage, nor did it correlate with PR, ER status and PCNA and c erbB2 expression. However, negative correlation was found between telomerase activity and accumulation of p53 proteins.Conclusion Detection of telomerase in breast fine needle aspirates complementary to cytological examination is useful in the diagnosis of breast cancer. Its possible association with p53 accummulation needs further study. Subject