EGFR、ALK基因在肺癌CT引导下穿刺活检标本中的检测

发布时间：2018-04-01 08:39

  本文选题：肺癌　切入点：基因突变　出处：《浙江大学》2015年硕士论文

【摘要】：目的：明确CT引导下肺癌穿刺活检EGFR及ALK基因的检出率和阳性率,并分析临床病理表现与基因突变的关系以及提高检出率相关的因素。方法：收集浙江省肿瘤医院2014年6月至2015年8月期间250例肺癌患者的临床资料及其CT引导下穿刺活检标本。根据肿块部位及其大小采取合适的穿刺针,其中细针穿刺50例,粗针200例。细针选用Cook 19G同轴半自动活检针或普利赛20G半自动活检针,粗针选用BioPince 17G同轴全自动活检针或普利塞18G、16G半自动活检针。运用ScorPions ARMS检测250例穿刺标本的EGFR基因,使用VentanaALK(D5F3)免疫组化方法检测250例穿刺标本ALK基因的表达。结果：250例NSCLC患者的活检标本中,103例存在EGFR基因突变,突变率为41.2%；其中以第19外显子缺失(44.7%)和第21外显子L858R突变(39.8%)多见；250例标本中共检测到15例(6%)ALK融合基因。EGFR基因女性患者突变率明显高于男性患者(62.1%,37.9%,P0.01,)；非吸烟患者的突变率明显高于吸烟患者(56.2%,25%,P0.01,)；而年龄以及分期与基因突变无相关性。组织学类型中腺癌EGFR基因突变率(56.6%,P0.01)明显高于鳞癌和其它类型肺癌。本研究没有发现ALK基因表达与性别、年龄、病理分化程度等因素的相关性(P0.05)；15例ALK基因阳性者全部不吸烟,均为腺癌,Ⅳ期患者ALK基因的突变比非Ⅳ期患者明显高(18.5%,1.8%,P0.01)。EGFR基因检出率为83.2%(208/250),粗针活检穿刺的检出率高于细针(91%,52%,P0.01),阳性率也高于细针(45.5%,24%,P0.01),粗针穿刺检出率高与粗针穿刺肿瘤细胞个数大于细针穿刺肿瘤细胞个数(P0.05)有关,而与粗细针肿瘤细胞比例无关(P0.05),其中肿瘤细胞数目大于50者检出率更高。ALK蛋白免疫组化检测检出率为87.2%,粗针活检穿刺的检出率高于细针(91%,72%,P0.01),但阳性率无差异(P0.05),粗针活检穿刺的检出率高低也与粗细针穿刺肿瘤细胞个数差异有关(P0.05),而与粗细针穿刺肿瘤细胞比例无关(P0.05)。结论：250例标本中EGFR基因及ALK基因的检出率分别为83.2%和87.2%,二者粗针活检穿刺的检出率均高于细针,但细针检出率仍不低,对于有细针穿刺适应症的患者,细针穿刺仍是首选。基因检出率的高低与肿瘤细胞个数有关,而与肿瘤细胞比例无关,肿瘤细胞数目大于50者检出率更高。
[Abstract]:Objective: to determine the detection rate and positive rate of EGFR and ALK gene in CT-guided biopsy of lung cancer. The clinical data of 250 patients with lung cancer from June 2014 to August 2015 in Zhejiang Provincial Cancer Hospital were collected and their CT guided data were collected to analyze the relationship between clinicopathological manifestations and gene mutation. Methods: the clinical data of 250 patients with lung cancer were collected from June 2014 to August 2015 in Zhejiang Cancer Hospital. Biopsy specimens. According to the location and size of the mass, take the appropriate puncture needle, There were 50 cases of fine needle puncture and 200 cases of thick needle. The fine needle was made of Cook 19G coaxial semi-automatic biopsy needle or primace 20g semi-automatic biopsy needle. BioPince 17G coaxial automatic biopsy needle or Prosser 18G ~ + 16G semi-automatic biopsy needle were used to detect the EGFR gene of 250 puncture specimens by ScorPions ARMS. The expression of ALK gene was detected by using the immunohistochemical method of Ventana ALKN D5F3.Results the EGFR gene mutation was found in 103 of the biopsy specimens from 250 patients with NSCLC. The mutation rate was 41.2; the mutation rate of female patients with 6ALK fusion gene. EGFR gene was significantly higher than that of male patients with exon 19 deletion 44.7and exon 21 L858R mutation 39.8%. The mutation rate of EGFR gene in adenocarcinoma was significantly higher than that in smoking patients (56.2%), but there was no correlation between age and stage. The mutation rate of EGFR gene in adenocarcinoma was significantly higher than that in squamous cell carcinoma and other types of lung cancer. No ALK gene expression and sex were found in this study. Age, pathological differentiation and other factors were correlated with P0.05 ALK gene positive in all 15 patients who did not smoke, all of them were adenocarcinoma. The mutation rate of ALK gene in stage 鈪，

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