胸水细胞蜡块在晚期肿瘤诊断及肺腺癌EGFR/ALK/ROS1检测中的应用

目的:分析胸水细胞蜡块在晚期肿瘤诊断及肺腺癌EGFR/ALK/ROS1检测中的应用价值。方法:收集胸水细胞学制片后剩余的细胞标本制备蜡块,行HE染色,对来源不同的肿瘤选择不同的抗体进行免疫组织化学标记,联合HE形态学及免疫组织化学结果对恶性胸水进行肿瘤分类,同时对明确诊断为肺腺癌的病例,进行EGFR/ALK/ROS1基因状态的检测。结果:79例患者中,60例检出恶性肿瘤细胞,15例为增生的间皮细胞,4例为极少量异型细胞,免疫组织化学难以做出准确标记。60例恶性肿瘤细胞中,腺癌51例,小细胞癌4例,鳞状细胞癌3例,梭形细胞肉瘤1例,弥漫大B细胞淋巴瘤1例。51例腺癌中,结合免疫组织化学标记及临床病史,肺腺癌43例,乳腺癌2例,卵巢高级别浆液性癌2例,胃癌2例,结肠癌1例,肝癌1例。在43例肺腺癌中,22例患者进行了EGFR/ALK/ROS1基因检测,结果显示EGFR突变率为54.5%(12/22例),ALK,ROS1基因融合突变率分别为9.1%和4.5%(2/22例和1/22例)。结论:利用胸水标本制备细胞蜡块,结合免疫组织化学标记有助于晚期肿瘤的诊断,并为肺腺癌患者个体化治疗方案的选择提供帮助。

Application of cell blocks of pleural effusion in diagnosis of advanced tumors and detection of EGFR/ALK/ROS1 in lung adenocarcinoma

Objective:To analysis the application value of cell block of pleural effusion in the diagnosis of advanced cancer and detection of EGFR/ALK/ROS1 in lung adenocarcinoma.Methods:The remaining cytological specimens after routine smear were collected to prepare pleural effusion cell block.HE staining was preformed.Different antibodies were selected according to different origins of tumor.We classify tumors of malignant pleural effusion combined with HE morphology and immunohistochemistry results.At the same time,the EGFR/ALK/ROS1 gene status was detected in cases with a clear diagnosis of lung adenocarcinoma.Results:In 79 patients,60 cases were found cancer cells,15 cases were proliferating mesothelial cells and 4 cases were atypical cells difficult to make an accurate judgment.Sixty malignant cases,51 cases were adenocarcinoma,4 cases small cell carcinoma,4 cases squamous cell carcinoma,1 case spindle cell sarcoma,and 1 case diffuse large B-cell lymphoma.According to immunohistochemistry and clinical history,43 cases were lung adenocarcinoma,2 cases breast cancer,2 cases ovary carcinoma,2 gastric adenocarcinoma,1 colon cancer,and 1 liver cancer.Forty-three lung adenocarcinoma cases,the EGFR/ALK/ROS1 gene tests were detected in 22 patients.The results showed that the EGFR mutation rate was 54.5%(12/22),and the ALK and ROS1 gene fusion mutation rates were 9.1%and 4.5%(2/22 and 1/1),respectively.Conclusion:Pleural effusion cell blocks,combined with immunohistochemical staining can help the diagnosis of advanced tumors and provide assistance in the selection of individualized treatment options for patients with lung adenocarcinoma.