摘要目的 探讨细针吸取细胞学传统涂片和液基薄片标本应用免疫细胞化学(ICC)检测肺腺癌淋巴结转移灶间变性淋巴瘤激酶(ALK,D5F3)蛋白表达的可行性.方法 收集147例进展期肺腺癌淋巴结转移灶的细针吸取细胞学标本,其中传统涂片47例,液基薄片100例,采用ICC法检测ALK蛋白的表达,并与逆转录聚合酶链反应(RT-PCR)、荧光原位杂交(FISH)检测结果进行比较.结果 ALK蛋白在肺腺癌淋巴结转移灶细针吸取细胞学标本中的阳性率为11.6％(17/147),其中在传统涂片和液基薄片中的阳性率分别为10.6％(5/47)和12.0％(12/100).147例标本中,有57例标本采用RT-PCR或FISH方法进行验证,其中阳性17例,阴性40例,总符合率为96.5％(55/57).肺腺癌淋巴结转移灶细针吸取细胞学标本检测ALK蛋白的灵敏度为94.1％(16/17),特异度为97.5％(39/40);其中传统涂片检测ALK蛋白的灵敏度为100％(5/5),特异度为100％(10/10);液基薄片检测ALK蛋白的灵敏度和特异度分别为91.7％(11/12)和96.7％(29/30).结论 肺腺癌患者无法获取手术标本或标本无法制成细胞块时,细针吸取细胞学传统涂片和液基薄片可以用来进行ALK蛋白的检测.

abstractsObjective To explore the feasibility of conventional smears and liquid-based cytologic slides of lymphatic metastasis specimens of lung adenocarcinoma acquired by fine needle aspiration cytology(FNAC)to detect the expression of anaplastic lymphoma kinase(ALK/D5F3)by immunocytochemistry(ICC)analysis.Methods The lymphatic metastasis specimens of 147 lung adenocarcinoma,including 100 liquid-based cytologic slides and 47 conventional smears,were collected in this study.ALK fusion protein was detected by Roche Ventana ICC technology,which was compared with the ALK fusion gene assessed by fluorescence in situ hybridization(FISH)or reverse transcriptase-polymerase chain reaction(RT-PCR).Results The positive rate of ALK(D5F3)fusion protein in advanced lung adenocarcinoma acquired by FNAC was 11.6％(17/147),and 10.6％(5/47)and 12.0％(12/100)were reached in conventional smears and liquid-based cytologic slides,respectively.Among 147 cases,57 cases including 17 positive cases and 40 negative cases were verified by RT-PCR and FISH.The whole coincidence rate reached 96.5％(55/57).The sensitivity and specificity of ALK(D5F3)fusion protein detected in lung adenocarcinoma acquired by FNAC were 94.1％(16/17)and 97.5％(39/40),respectively.The sensitivity and specificity were both 100％(5/5 of sensitivity and 10/10 of specificity)in conventional smears,while 91.7％(11/12)and 96.7％(29/30)in liquid-based cytologic slides.Conclusion Conventional smears and liquid-based cytologic slides of FNAC samples can be used to perform ICC analysis of ALK(D5F3)expression in advanced lung adenocarcinoma,especially for patients who have no opportunity for surgery or whose resected samples are difficult to form cell block.