p63蛋白在乳腺良、恶性疾病鉴别诊断中的意义

目的检测p63蛋白在乳腺肌上皮细胞表达的敏感性和特异性。方法收集乳腺良、恶性病变的石蜡包埋标本50例(纤维腺瘤、纤维囊性病、导管内乳头状瘤、良性叶状肿瘤、导管内癌、浸润性导管癌、浸润性小叶癌)，采用免疫组化单标记(p63)和双标记(p63／SMA)的方法检测p63在上述病变中的表达。结果在乳腺的良性病变中几乎所有的肌上皮细胞都表达p63。除1例纤维腺瘤中有少许腺上皮细胞表达p63外，其余病例的腺上皮细胞都不表达p63。在导管内癌中，一些外周可见完整的p63阳性的肌上皮细胞环绕(23．8％)，部分肌上皮细胞不完整(62．4％)，甚至无肌上皮细胞(13．8％)。而在浸润性癌的癌细胞巢外缘未见p63阳性的肌上皮细胞。在乳腺的所有良、恶性病变中，间质的肌纤维母细胞和血管平滑肌细胞都不表达p63。结论p63标记乳腺肌上皮细胞具有较高的敏感性和特异性，可以作为肌上皮细胞的又一有效的标记物，有助于我们在疑难的乳腺病变中正确识别肌上皮细胞。

Role of p63 protein in differential diagnosis of breast benign and malignant lesions

Objective To detect the sensitivity and specifity of p63 protein expression in breast myoepithelial cells. Methods We collected 50 cases of breast benign and malignant paraffin-embedded samples (including fibroadenoma, fibrocystic disease, intraductal papilloma, benign phyllodes tumor, intraductal carcinoma, invasive ductal carcinoma and invasive lobular carcinoma), and detected the expression of p63 in above breast lesions by immunohistochemistry (p63) and double immunostaining (p63/SMA). Results In breast benign lesions, almost all of the myoepithelial cells were p63 positive, and all the breast epithelial cells were negative except that few of epithelial cells were positive in a case of fibroadenoma. In intraductal carcinomas, some cancer cell nests (23.8%) showed continuous positive cells in their circumference; others showed discontinuous positive cells or entirely no positive cells (62.4% and 13.8% respectively). There were no p63 positive cells in invasive carcinomas. The stromal myofibroblasts and vascular smooth muscle cells were all p63 negative in 50 cases of breast benign and malignant lesions. Conclusion Being able to label myoepithelial cells with high sensitivity and specificity, p63 may be a useful myoepithelial cells marker and could help us to recognize myoepithelial cells correctly in confusing breast lesions.