免疫组化表达在乳腺癌前驱病变与微浸润性癌鉴别诊断中的应用

摘要

目的：探讨分子标记物免疫表型在正常乳腺组织及癌前病变、浸润癌诊断和鉴别诊断中的应用。方法检测30例正常乳腺组织、20例非典型导管增生（ADH）、60例导管原位癌（DCIS）、20例小叶原位癌（LCIS）、90例浸润性癌（IDC）中 CK5/6、CK34βE12、P63、HHF-35、CK19、E-cadherin、P120-catenin 的表达，及其诊断和鉴别诊断价值。结果（1）30例正常乳腺组织定向干细胞 CK5/6阳性，CK19、HHF-35阴性；腺中间细胞表达 CK5/6和 CK19，腺终端细胞仅表达 CK19；肌中间细胞表达 CK5/6和 HHF-35，终端细胞仅表达 P63、HHF-35。（2）普通型导管增生（UDH）与 ADH 及低级别 DCIS 鉴别诊断：26例 UDH 导管周肌上皮 P63、HHF-35阳性，管内细胞 CK5/6、CK19、ER 阳性呈明显异质性，CK5/6、CK34βE12、P63、HHF-35呈马赛克样表达模式；ADH 不表达 CK34βE12和 CK5/6。（3）ADH 和低级别 DCIS 鉴别：17例 ADH、49例 DCIS 导管周肌上皮 CK5/6、CK34βE12、P63、HHF-35连续阳性，3例 ADH、11例部分导管肌上皮间断或连续阳性；管内细胞 CK5/6阴性，增生区内细胞 CK19弥漫阳性。（4）CK5/6、P63、HHF-35鉴别高级别 DCIS 及 IDC：高级别 DCIS 管周肌上皮 CK5/6、CK34βE12、P63、HHF-35阳性， IDC 则阴性。（5）导管原位癌小叶化与小叶原位癌：CK5/6、CK34BE12、E-caderin 及 P120组合可鉴别。结论免疫组化 CK5/6、34βE12、P63、HHF-35、CK19、E-cadherin 、P120-catenin 组合对乳腺癌前病变与早期微浸润癌具有辅助鉴别价值。%Objective Toinvestigatetheimmunophenotypicfeaturesofmolecularmarkersofbreast carcinoma and precancerous lesions. Methods The molecular markers staining modes of CK5/6、CK34βE12、P63、HHF-35、CK19、E-cadherin、P120-catenin in 30 cases normal breast tissues, 20 cases of ADH, 60 cases of DCIS, and 90 cases of carcinoma were observed. Results 30 cases of normal breast tissue stem cells only express CK5/6, not express CK19 or HHF 35; Gland cells both express CD5/6 and CK19; CK19 were only expressed in glandular terminal cells; Myoepithelial cells among both CK5/6, also expressed HHF-35; Myoepithelial cell terminal both express HHF-35 and P63. 30 cases of UDH were diagnosed as principal disease. Myoepitheliums at the periphery of ducts were all stained positive for CK5/6,P63, HHF-35. The hyperplasia areas were scatteredly stained positive forCK5/6、CK19、P63、HHF-35. ADH didn't express CK34βE12 and CK5/6, and it was an important distinction between ADH and UDH . CK5/6,CK34βE12,P63 and HHF-35 were the most practical, valuable antibodies in diagnosis and differential diagnosis of breast cancer and Precancerous lesions ; CK5/6, CK34βE12, E-caderin and P120-catenin combination detection can identify ductal carcinoma in situ and lobular carcinoma in situ. Conclusion The kinds of immunomarkers of CK5/6, CK34βE12, P63, HHF-35, CK19, E-cadherin, and P120-cateninwhich have practical value in identification of breast carcinoma and precancerous lesions.