SOX10、GATA3、GCDFP15、雄激素抗体和乳腺球蛋白在三阴性乳腺癌与TTF-1阴性肺腺癌鉴别诊断中的价值

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  --本文经《美国外科病理学杂志》授权发布,其他媒体转载或引用须经《美国外科病理学杂志》同意,否则追究法律责任。
  三阴性乳腺癌(triple-negative breast cancer,TNBC)患者发生脏器转移和其他原发性非乳腺癌,尤其是肺癌的发病风险会增加。由于缺乏TNBC的典型免疫表型,TNBC转移灶与来自其他器官原发癌的鉴别诊断可能存在困难。我们分析了207例TNBC和152例原发性肺腺癌(lung adenocarcinomas,LA)中雌激素受体、孕激素受体、人类表皮生长因子受体、甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)、NapsinA、乳腺球蛋白、巨大囊肿病液体蛋白15(gross cystic disease fluid protein 15,GCDFP15)、Sry相关HMg-盒基因10(Sry-related HMg-Box gene 10,SOX10)、GATA结合蛋白3(GATA-binding protein 3,GATA3)和雄激素受体的表达。所有检测的TNBC均不表达TTF-1和NapsinA。当TNBC与TTF-1阳性或阴性LA进行比较时,无论LA是否表达TTF1,SOX10作为1种支持TNBC诊断的标志物,其敏感性(62.3%)和特异性(100%)均最佳(P<0.0001)。GATA3具有中等敏感性(30.4%)和非常好的特异性(98.7%),在152例LA中只有2例(1.3%)被错误分类。GCDFP15具有中度敏感性(20.8%)和非常好的特异性(98%),在152例LA中只有3例(2%)被错误分类。乳腺球蛋白和雄激素受体具有中度敏感性(38.2%和30%),良好的特异性(81.6%和86%),152例LA中分别有28例和21例被错误分类。多因素分析中,能够区分SOX10阴性TNBC和TTF-1、NapsinA阴性LA的最佳标志物为GATA3(比值比=33.5;95%置信区间,7.3~153.5;P<0.0001)和GCDFP15(比值比=31.7;95%置信区间,6.9~145.6;P<0.0001)。207例TNBC中只有13例(6.3%)不表达上述标志物。根据我们的研究结果,在鉴别TNBC和TTF-1阴性LA时,抗体的选择顺序首先是SOX10,其次是GATA3,最后是GCDFP15。这一顺序对于有TNBC病史女性进行肺结节穿刺活检诊断尤为重要。
 
 Am J Surg Pathol 2019;43:293–302
  美国外科病理学杂志中文版2019年第四期摘要NO.5
  (方 媛 翻译 黄文斌 审校)

  The American Journal of Surgical Pathology中文版声明:
  ©2018 Wolters Kluwer Health
  The material is published by Wolters Kluwer Health with the permission of American Journal of Surgical Pathology.No part of this publication may be reproduced in any form,stored in a retrieval system or transmitted in any form,by any means,without prior written permission from Wolters Kluwer Health.Opinions expressed by the authors and advertisers are not necessarily those of the American Journal of Surgical Pathology, its affiliates,or of the Publisher.The American Journal of Surgical Pathology,its affiliates,and the Publisher disclaim any liability to any party for the accuracy,completeness,efficacy,or availability of the material contained in this publication (including drug dosages) or for any damages arising out of the use or non-use of any of the material contained in this publication.
  Although advertising material is expected to conform to ethical (medical) standards,inclusion in this publication does not constitute a guarantee or endorsement of the quality or value of such product or of the claims made of it by its manufacturer.

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