摘要目的 比较双色银染原位杂交(DSISH)与荧光原位杂交(FISH)两种技术在胃癌HER2检测中的优缺点,评价DSISH用于胃癌患者HER2基因扩增状态检测的可行性.方法 收集2009年1月至3月在四川大学华西医院行根治性手术的原发性胃或胃食管交界处腺癌80例,行全自动免疫组织化学(IHC)染色检测HER2蛋白表达,所有标本行FISH和全自动DSISH检测HER2基因状态,比较不同检测方法之间的符合率.结果 DSISH和FISH初检均有5例失败,经重复检测后结果满意.IHC检测3+的13例中DSISH检测12例、FISH检测11例为HEB2基因扩增;IHC检测2+的6例中DSISH、FISH检测均有1例为基因扩增;IHC检测1+的18例中DSISH、FISH检测均有2例为基因扩增;IHC检测为0的43例中DSISH、FISH检测均无基因扩增.80例原位杂交病例中,仅1例检测结果不一致(DSISH有基因扩增而FISH无基因扩增),两种方法的总体符合率为98.8%(79/80,κ=0.958,P＜0.01).结论 DSISH技术用于胃癌HER2基因检测结果与FISH符合率高.DSISH与FISH检测各有优缺点,DSISH更具有可行性和实际应用价值.

abstractsObjective To investigate the advantages and disadvantages of dual-color silverenhanced in-situ hybridization(DSISH)and fluorescence in-situ hybridization(FISH)for determination of HER2 gene status in gastric carcinoma and to evaluate tlle feasibility of DSISH.Methods Eighty cases of primary gastric or gastroesophageal junction adenecarcinomag diagnosed and treated surgically from January to March.2009 at the West China Hospital were enrolled in the study.Automated immunohistochemistry (IHC)staining,FISH and automated DSISH were carried out to detect the HER2 status,respectively,and the concordance ofthe three techniques was then evaluated.Results DSISH and FISH failed initially,but repeated detection Was successful in 5 eases.Gene amplification was detected in 12/13 IHC 3+ cases in DSISH and in 11/13 IHC 3+ cases in FISH.In 6 IHC 2+cages, the amplification rate was both 1/6;in 18 IHC 1+cases.the amplifieation rate was both 2/18.No amplification Was observed in 43 IHC 0 cases.Only one of the 80 cases showed discrepancy.and tIlerefore the overall concordance between FISH and DSISH Wag 98.8%(κ=0.958,P＜0.01).Conclusions DSISH represents a novel approach for the determination of HER2 status in gastric carcinoma, and the overall concordance between DSISH and FISH is excellent.Despite their advantages and disadvantages.DSISH is more feasible and practical for routine application in surgical pathology.