| Wei Luan,Nier Cha,Yinzai He,Baoqing Jia. Application of malignant pleural effusion cell blocks in the diagnosis and personalized treatment of advanced non-small cell lung carcinoma. Oncol Transl Med, 2019, 5: 109-113. |
| 恶性胸腔积液细胞块在晚期非小细胞肺癌个体化诊疗中的应用研究 |
| Application of malignant pleural effusion cell blocks in the diagnosis and personalized treatment of advanced non-small cell lung carcinoma |
| Received:January 21, 2019 Revised:July 09, 2019 |
| DOI：10.1007/s10330-019-0331-1 |
| 中文关键词: 胸腔积液；细胞块；免疫细胞化学；EGFR |
| 英文关键词: pleural effusion; cell block; immunocytochemistry; epidermal growth factor receptor (EGFR) |
| 基金项目:本研究受内蒙古自治区自然基金面上项目资助(No. 2017MS08147) |
| Author Name | Affiliation | E-mail | | Wei Luan | Departments of Oncology, Inner Mongolia people''s Hospital | luan1977@126.com | | Nier Cha | Departments of Surgical Oncology, Inner Mongolia people''s Hospital | | | Yinzai He | Departments of Surgical Oncology, Inner Mongolia people''s Hospital | | | Baoqing Jia* | Departments of Surgical Oncology, Inner Mongolia people''s Hospital | 13604715646@qq.com |
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| 中文摘要: |
| 【摘要】 目的 探讨基于细胞块基础上的免疫细胞化学和相关基因检测在晚期肺癌诊断及个体化治疗中的应用。方法 收集65例恶性胸腔积液标本制作细胞块，应用常规染色、免疫细胞化学染色、基因测序等方法对其进行检测，指导肿瘤个体化诊疗。结果 细胞块切片中肿瘤细胞含量丰富、结构清晰，并保持部分组织学形态特征，免疫细胞化学染色有助于鉴定细胞性质和来源，ARMS法可明确EGFR基因突变状态。65例样本，诊断腺癌50例，肺鳞状细胞癌7例，肺小细胞癌6例，胸膜间皮瘤2例。不同组织来源肿瘤细胞各具特征：腺癌细胞呈腺样、乳头状或散在排列；鳞癌细胞可见细胞间桥；小细胞其形态与细胞涂片相似。综合免疫细胞化学染色结果及临床资料分析，确诊50例腺癌中包括肺腺癌40例，乳腺癌4例，卵巢腺癌3例，大肠癌3例。针对47例NSCLC患者，采用ARMS法检测到26例 (55.3％)存在EGFR突变。26例样本中检测到4种突变类型：外显子19缺失突变（13例，50.0%），外显子2l点突变L858R（11例，42.3%）及L861Q（1例，3.8%），外显子18点突变G719X（1例，3.8%）。结论 恶性胸腔积液细胞块结合免疫细胞化学标记和分子病理技术有助于晚期肿瘤的诊断，有助于明确肿瘤性质及组织学来源，为晚期肺癌个体化治疗方案的选择提供帮助。
【关键词】 胸腔积液；细胞块；免疫细胞化学；EGFR |
| 英文摘要: |
| Objective The aim of the study was to investigate the efficacy of immunocytochemistry and related gene
detection using cell block for the diagnosis and individualized treatment of advanced lung cancer.
Methods Sixty-five malignant pleural effusion specimens were collected to make cell blocks, which were
used for hematoxylin and eosin (H&E) staining, immunocytochemical studies, and gene sequencing of the
tumors to guide the individualized diagnoses and treatment of the given tumors.
Results The tumor cells in the cell block sections were abundant in number with high quality cellular
structures, and the histological morphological characteristics were partially maintained. Immunocytochemical
staining was helpful in identifying the cell origin and tumor classification, and amplification refractory mutation
system (ARMS) was used to determine the mutation status of epidermal growth factor receptor (EGFR). Of
the 65 samples, 50 had a diagnosis of adenocarcinoma, 7 were pulmonary squamous cells, 6 were small
cell carcinoma of the lung, and 2 were mesothelioma. The morphological features of the tumors were as
follows: acinar formation, papillary and single cells for adenocarcinoma; intercellular bridges for squamous
cell carcinoma; and morphology of the small cells is similar to that of the smear. Correlating with the
results of immunocytochemical staining and clinical data analysis, 40 cases were confirmed as pulmonary
adenocarcinoma, with an additional 4 cases of breast cancer, 3 cases of ovarian adenocarcinoma, and 3
cases of colorectal adenocarcinoma. Of the 47 non-small cell lung carcinoma (NSCLC) patients, EGFR
mutations were detected in 26 cases (55.3%) by ARMS, with four mutation types: exon 19 deletion (13
cases, 50.0%), exon 2l point mutations L858R (11 cases, 42.3%) and L861Q (1 case, 3.8%), and exon 18
point mutation G719X (1 case, 3.8%).
Conclusion Malignant pleural effusion cell blocks combined with immunocytochemical markers and
molecular pathology are helpful for the diagnosis of advanced tumors, the identification of tumor properties
and histological tumor origin, and the selection of individualized treatment for advanced lung cancer. |
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