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
  --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)

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