CAJ | 학술논문

目的探讨细针吸取(FNA)标本检测晚期乳腺癌人表皮生长因子受体2(HER-2)基因扩增和蛋白表达的可行性,为乳腺癌患者临床靶向用药提供依据.方法选取49例乳腺癌FNA液基标本,采用免疫细胞化学(ICC)和荧光原位杂交(FISH)法检测HER-2蛋白表达和基因扩增.49例乳腺癌患者均为术后石蜡包埋切片免疫组织化学(IHC)检测HER-2蛋白表达++或+++,并且每例均有对应的组织标本HER-2 FISH检测结果.结果 49例FNA标本的FISH检测结果与组织学标本的FISH检测结果完全符合(kappa=1.0),33例组织学标本检测到HER-2基因扩增者,FNA标本也同样检测到HER-2基因扩增,扩增率均为67.3％.HER-2基因扩增的33例病例中,ICC检测HER-2蛋白表达+++者26例,占78.8％;IHC检测HER-2蛋白表达+++29例,占87.9％,ICC和IHC检测结果差异无统计学意义(P=0.322).16例细胞学与组织学两种标本均无基因扩增者中,除1例因细胞量少ICC检测不满意外,其余15例ICC检测HER-2蛋白表达均为0/+;IHC检测15例HER-2蛋白表达均为++,1例为+++.以FISH检测结果为金标准,ICC检测具有比较高的敏感性和特异性,分别为87.9％和100.0％.结论 FNA液基标本可以应用于临床检测乳腺癌患者HER-2基因扩增和蛋白表达,并且ICC检测有较高的敏感性和特异性.对于晚期乳腺癌及其复发和转移患者,可以使用FNA液基标本检测HER-2.当ICC检测HER-2蛋白表达+++时,提示HER-2基因扩增.
목적 탐토세침흡취(FNA)표본검측만기유선암인표피생장인자수체2(HER-2)기인확증화단백표체적가행성,위유선암환자림상파향용약제공의거.방법 선취49례유선암FNA액기표본,채용면역세포화학(ICC)화형광원위잡교(FISH)법검측HER-2단백표체화기인확증.49례유선암환자균위술후석사포매절편면역조직화학(IHC)검측HER-2단백표체++혹+++,병차매례균유대응적조직표본HER-2 FISH검측결과.결과 49례FNA표본적FISH검측결과여조직학표본적FISH검측결과완전부합(kappa=1.0),33례조직학표본검측도HER-2기인확증자,FNA표본야동양검측도HER-2기인확증,확증솔균위67.3％.HER-2기인확증적33례병례중,ICC검측HER-2단백표체+++자26례,점78.8％;IHC검측HER-2단백표체+++29례,점87.9％,ICC화IHC검측결과차이무통계학의의(P=0.322).16례세포학여조직학량충표본균무기인확증자중,제1례인세포량소ICC검측불만의외,기여15례ICC검측HER-2단백표체균위0/+;IHC검측15례HER-2단백표체균위++,1례위+++.이FISH검측결과위금표준,ICC검측구유비교고적민감성화특이성,분별위87.9％화100.0％.결론 FNA액기표본가이응용우림상검측유선암환자HER-2기인확증화단백표체,병차ICC검측유교고적민감성화특이성.대우만기유선암급기복발화전이환자,가이사용FNA액기표본검측HER-2.당ICC검측HER-2단백표체+++시,제시HER-2기인확증.
Objective To explore the feasibility of testing HER-2 expression and gene amplification in fine needle aspiration specimens of advanced breast cancers,and to benefit the patients receiving targeted drug therapy.Methods Liquid-based cytology specimens by fine needle aspiration of 49 breast cancer cases were used in this study.The expression of HER-2 protein was detected by immunocytochemistry (ICC) and the gene amplification was assessed by fluorescence in situ hybridization (FISH).All the 49 cases had overexpression of HER-2 protein marked as + + or + + + in immunohistochemistry (IHC),and had corresponding FISH results in formalin-fixed,paraffin-embedded (FFPE) tissue samples.Results FNA samples in all the 49 cases were tested by FISH,and showed a complete agreement with the FISH results in the histological specimens (kappa =1.0).Of the 49 cases,33 had HER-2 gene amplification in FFPE samples.So do that in FNA samples.Both had an amplification rate of 67.3％.Among the 33 cases with HER-2 gene amplification,26 had an ICC score of + + + (78.8％).The conformity rate was 78.8％.Of the 33 cases,29 had an IHC score of + + + (87.9％).Its conformity rate was 87.9％.The difference between the ICC and IHC results was statistically not significant (P =0.322).Among the 16 cases with negative gene amplification by both ICC and IHC,15 cases showed HER-2 protein expression as 0/+,and another one case was not counted because there was not enough cells.Of the 16 cases,15 had an IHC score of + + and one of + + +.To take the FISH results as gold standard,ICC results had a high sensitivity (87.9％) and specificity (100.0％).Conclusions FISH in FNA samples can be used in the clinic to test HER-2 gene amplification and overexpression in breast cancers,with a high sensitivity and specificity in ICC.Our data support the use of FISH and ICC analysis to determine HER-2 status on FNA specimens in patients with advanced breast cancer and recurrence or metastatic tumors.When ICC score is + + +,it indicates that there is a HER-2 gene amplification by FISH.