快速免疫组织化学技术在甲状腺肿瘤术中冷冻诊断中的应用

 目的　探讨快速免疫组化（IHC）新方法及其在甲状腺肿瘤术中冷冻诊断中的应用价值。方法　采用MaxVision快速免疫组化一步法检测CK19、HBME-1、Gla-3在甲状腺乳头状癌（PTC）及甲状腺良性病变组织冷冻切片中的表达，以冰剩组织MaxVision常规IHC作对照。结果　MaxVision快速IHC一步法在20 min内完成，三种标记阳性定位与常规IHC基本对应一致，表达部位CK19位于细胞质和细胞膜，Gla-3、HBME-1以滤泡腔缘或（和）乳头表面为主，表达强度强于常规IHC。冷冻切片快速IHC CK19、HBME-1、Gla-3阳性表达率：良性病变（结节性甲状腺肿、慢性淋巴细胞性甲状腺炎、腺瘤）为0、10.7 %（3／28）、0，PTC为94.9 %（37／39）、92.3 %（36／39）、92.3 %（36／39），三种标记在甲状腺良性病变与PTC间表达差异均有统计学意义（χ2值分别为59.326、55.861、44.605，均P＜0.05）；同一病例两种以上标记阳性在良性病变为0，PTC为100 %，差异有统计学意义（χ2＝67.000，P＜0.05）。结论　MaxVision快速IHC一步法可以应用于术中冷冻诊断，联合检测CK19、HBME-1、Gla-3对PTC术中冷冻诊断具有较高辅助诊断价值。

Application of rapid immunohistochemical staining technique in intraoperative frozen section diagnosis of thyroid neoplasm

Objective To investigate the application of rapid immunohistochemical staining technique in intraoperative frozen section diagnosis of thyroid neoplasm. Methods MaxVision one-step rapid immunohistochemical staining technique was used to detect the expression of CK19,HBME-1,and Gal-3 in frozen section of papillary thyroid carcinoma (PTC) and thyroid benign lesions.MaxVision conventional immunohistochemistry of frozen remaining tissue was served as control.Results MaxVision one-step rapid immunohistochemical staining technique could be completed in 20 minutes.The positive localizations of three markers detected by rapid immunohistochemistry were similar to conventional immunohistochemistry, in general.The expression of CK19 was located in cytoplasm and cellular membrane.Gal-3 and HBME-1 were mainly detected in follicular luminal border and/or surface of papilla. The staining intensity in rapid immunohistochemistry was stronger than that in conventional immunohistochemistry. The positive rates of CK19,HBME-1,and Gal-3 by rapid immunohistochemistry in frozen sections were: 0 (0/28),10.7 ％ (3/28),0 (0/28),respectively,for benign lesions (nodular goiter,Hashimoto thyroiditis,thyroid adenoma); and 94.9 ％(37/39),92.3 ％ (36/39),92.3 ％ (36/39),respectively,for PTC.The expression of three markers between thyroid benign lesions and PTC had a significant difference (x2 =59.326,55.861,44.605,all P ＜ 0.001).In benign lesions,the rate of same case with two and more positive markers was 0,while in PTC it was 100 ％ and significantly different (x2 =67.000,P ＜ 0.05).Conclusion MaxVision one-step rapid immunohistochemical staining technique could be applied in intraoperative frozen section diagnosis.Detecting CK19,HBME-1,and Gal-3 expression in intraoperative frozen section has an auxiliary value for diagnosis of PTC.