检测Mesothelin蛋白表达对胰腺细针穿刺标本的诊断价值

目的探讨检测mesothelin蛋白表达对内镜超声引导下胰腺细针穿刺(EUS-FNA)标本的诊断价值.方法采集27例胰腺实性占位病变患者的EUS-FNA标本,采用EnVision免疫组织化学方法检测mesothelin蛋白的表达情况,并与细胞学检查结果及最后确诊结果进行比较.结果在27例患者中,最终诊断为胰腺癌19例,良性病变8例.其中,细胞学检查恶性的10例患者最后均确诊为胰腺癌;细胞学检查可疑恶性或见到异型细胞的11例患者中,有7例最后确诊为胰腺癌,4例为良性病变;细胞学检查良性的6例患者中,有2例最后确诊为胰腺癌,4例为良性病变.在19例确诊为胰腺癌的患者中,有14例mesothelin蛋白免疫组织化学染色呈阳性(敏感性73.7%);而在8例良性病变标本中,有7例mesothelin蛋白染色呈阴性(特异性87.5%).7例细胞学检查可疑而最后确诊为胰腺癌的患者中,5例有mesothelin蛋白表达(敏感性71.4%,特异性75%),4例最终确诊良性病变的可疑恶性病例中有1例mesothelin蛋白染色呈阳性.结论mesothelin在EUS-FNA标本中的表达有较高的特异性,检测mesothelin的表达对鉴别诊断细胞学检查可疑恶性病例具有一定价值.

Expression and diagnostic value of mesothelin in specimen of pancreas fine-needle aspiration

Objective To investigate the expression of mesothelin in specimen of pancreas fine-needle aspiration and to evaluate the potential contribution of immunohistochemical labeling of mesothelin to the interpretation of pancreas fine-needle aspiration(FNA). Methods Specimens from 27 patients were selected for immunolabeling. Immunohistochemical EnVision method was used to detect the expression of mesothelin in specimen of pancreas fine-needle aspiration. The labeling in each patient was scored as positive or negative. These results were compared with the cytologic diagnosis and the follow-up data. Results Nineteen of the 27 patients were ultimately shown to have an adenocarci- noma, and 8 had no evidence of malignancy on follow-up. Initial cytologic diagnosis of malignancy correlated with carcinoma on follow-up in 10 of 10 cases, and initial benign cytologic diagnosis correlated with benign follow-up in 4 of 6 cases. Seven of the 11 patients with suspicious cytology were found to have carcinomas on follow-up. Mesothelin labeling was seen in 14 of the 19 patients ultimately shown to have carcinomas and was absent in 7 of the 8 benign lesions(sensitivity, 73.7%;specificity, 87.5%). Five of the 7 cytologically suspicious cases with malignant follow-up labeled for mesothelin. Positive mesothelin labeling was observed in one of the 4 suspicious cases who finally proved to be benign during follow-up. Conclusion Immunohistochemical labeling for mesothelin may be a highly specific tool for the detection of pancreatic adenocarcinoma in FNA specimens and is useful in categorizing cytologically suspicious lesions.