肝癌免疫组化诊断谱的研究和应用

目的：探讨鉴别肝细胞癌（HCC）、肝内胆管癌（ICC）和肝转移性腺癌（MAC）的免疫组化诊断谱特点。方法：对手术切除的300例HCC、35例ICC和30例MAC分别进行AFP、Hep Pau 1、CK18、CK19、CA19－9、CD34和pCEA等7种免疫组化染色,将特异性和敏感性的综合性能计分（CCS）≥8分的抗体定为具有高度诊断价值。结果：CCS≥8分的抗体在HCC中为Hep Par 1和CD34,在ICC中为CK19,在MAC中无。Hep Par 1的CCS（9分）明显高于AFP（7分）,其对HCC的敏感性达到83.7%,特异性达到96．7％。结论：HCC的一线抗体由Hep Par 1和CD34组成,二线抗体由pCEA和AFP组成：ICC的一线抗体为CK19,二线抗体为CA19－9。由3种一线抗体组合成肝癌的核心免疫组化谱,酌情使用二线抗体,可以较好地解决对HCC、ICC和MAC之间的免疫病理诊断和鉴别诊断。

Immunohistochemical spectrum in the detection and differentiation of intrahepatic neoplasms

OBJECTIVE: To scrutinize the immunohistochemical spectrum to differentiate hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC) and metastatic adenocarcinoma (MAC) in the liver. METHODS: Seven antibodies including AFP, Hep Par 1, CK18, CK19, CA19-9, CD34 and pCEA were immunohistochemically stained in resected specimens of 300 HCC, 35 ICC and 30 MAC. The specificity and sensitivity of the antibodies were evaluated by comprehensive capability score (CCS), with only those with CCS > or = 8 considered as having highly diagnostic value. RESULTS: Antibodies CCS > or = 8 were observed as Hep Par 1 and CD34 in HCC, and CK19 in ICC, but none in MAC. For HCC, CCS of Hep Par 1 was higher than that of AFP (9 vs. 7) with 83.7% in sensitivity and 96.7% in specificity. CONCLUSION: For HCC, Hep Par 1 and CD34 can be used as the first line antibodies, AFP and pCEA as the second line ones. CK19 is the first line antibody for ICC, and CA19-9 as the second. Hep Par 1, CD34 and CK19 are definitely helpful for the routine immunohistochemical stain to differentiate HCC from ICC and MAC.