纤维支气管镜活检病变组织标本和痰标本Survivin基因的检测对肺癌的诊断价值

目的明确纤维支气管镜(以下简称纤支镜)活检病变组织和痰标本中SurvivinmRNA的检测在肺癌诊断中的意义。方法应用逆转录聚合酶链反应(RT PCR)法检测41例肺癌手术标本癌组织、癌旁组织和9例良性肺疾病病变组织手术标本,80例肺癌和30例良性肺疾病纤支镜活检病变组织标本及所有(160例)患者痰标本SurvivinmRNA表达情况,并与病理组织学、刷检细胞学和痰细胞学检查结果比较。结果肺癌手术切除标本癌组织SurvivinmRNA的阳性率为70.7%(29/41),高于癌旁组织[17.1%(7/41)]和良性肺疾病组织(1/9),差异有统计学意义(χ2值分别为23.97和10.93,P均<0.05),而癌旁组织与肺良性疾病组织相比,差异无统计学意义(χ2=0.20,P>0.05);纤支镜活检肺癌组织标本SurvivinmRNA的阳性率为63.8%(51/80),高于良性肺疾病的13.3%(4/30,χ2值为22.18,P<0.05);肺癌患者癌组织SurvivinmRNA表达与否及表达水平与患者年龄、性别及肿瘤的病理分型、分级、部位及转移情况均无明显相关性(P均>0.05)。肺癌患者痰标本SurvivinmRNA的阳性率是59.5%(72/121),癌细胞的检出率是47.1%(57/121);痰Survivin mRNA检测联合痰细胞学检查诊断肺癌的敏感性为80.2%(97/121),高于单独痰细胞学及单独痰SurvivinmRNA检测的敏感性(P均<0.05)。手术标本、纤支镜活检标

The expression of survivin messenger RNA in sputum and cancerous tissue in human lung cancer

Objective To study the diagnostic significance of the expression of survivin mRNA in transbronchial biopy samples and sputum samples in lung cancer. Methods The resected lung cancer tissues and their para-carcinomatous normal tissue specimens of 41 patients with lung cancer and tissue specimens of 9 patients with benign pulmonary diseases were studied. 110 bronchial biopsy specimens from 80 patients with lung cancer and 30 patients with benign pulmonary diseases and their 160 sputum samples were also evaluated. RT-PCR was performed for the detection of survivin mRNA expression in specimens. The results were compared with their histological or cytological examinations. Results (1) The positive rate of survivin mRNA in resected lung cancer tissues (29/41; 70.7%) was higher than that in the para-carcinomatous normal tissues (7/41;17.1%) and the benign pulmonary tissues(1/9; 11.1%, P<0.05). There was no statistical difference (P>0.05) in the positive rate of survivin mRNA between para-carcinomatous normal tissues and the benign pulmonary disease tissues. In the bronchial biopsy samples, the positive rate of survivin mRNA in 80 lung cancer tissues(51/80;63.8%) was also higher than that in the benign pulmonary tissues (4/30; 13.3%, P<0.05). There were no relationships between survivin mRNA expression and age, sex, histopathological subtype, differentiation, or lymph node metastases of the patients. The sensitivity and specificity of diagnosis for lung cancer by detecting survivin mRNA in resected cancer tissue and transbronchial biopsy tissue were 63.8%-70.7% and 86.7%-88.9%, respectively. (2) The sensitivity of cytological examinations combined with detecting survivin mRNA in sputum samples was higher than that of either cytological examination or survivin mRNA detection of sputum samples alone (P<0.05). The sensitivity of the diagnosis for lung cancer increased from 47.1% (sputum cytology alone) to 80.2%( sputum survivin mRNA detection combined with sputum cytology, P<0.05) and the negative predictive value increased from 37.9% for sputum cytology alone to 57.9%(P< 0.01) for sputum survivin mRNA detection combined with sputum cytology. The specificity did not change significantly.Conclusions Detecting survivin mRNA expression from bronchial biopsy specimens might be used as one of the specific molecular markers for diagnosis of lung cancer, while the detection of survivin mRNA from sputum samples as a new ancillary diagnostic method for lung cancer.