Application Of Cell Block In Diagnosis And Molecular Detection Of Advanced Non-small Cell Lung Cancer

Objective The investigation on the value and clinical significance of cell wax block in pathological diagnosis and molecular diagnosis of the patients with non-small cell lung cancer(NSCLC).Methods: Collected the information of 30 NSCLC patients with malignant pleural effusion but without radiochemotherapy in Jiujiang No.1 People's Hospital from January 2014 to June 2017,recording their sex,age,the color of pleural effusion,its transparency and nature.Made pleural effusion for one liquid-based cell smear,then the remaining was centrifuged to obtain tumor cell sediment to make cell wax block.Divided into groups: the experiment was divided into two groups,the experiment group was cell wax block of NSCLC,the control group was the corresponding biopsy specimen.By the method of immunohistochemistry,tested the expression of cell keratin 7(Cell Keratin 7,CK7),p40(Delta-Np63),aspartic peptide enzyme A(Napsin A),thyroid transcription factor-1(Thyroid transcription factor-1,TTF-1),nerve cell adhesion molecules(Neura cell adhesion molecules,CD56)? Synaptothysin(Syn)?Chromogranin A(Cg A)and p63?Calretinin(CR)in two groups,compared and analyzed the immunostains difference between cell wax block and the corresponding biopsy specimen.After immunohistochemistry typing,adopted the method of amplification refractory mutation system(ARMS)based on real-time fluorescent quantitative PCR,tested the mutation patterns of Epithelial Growth Factor(EGFR)exon 18,19,20 and 21,analyzed gene mutation in different types of lung cancer and compared EGFR mutation difference between two specimens.Done statistics and analyzed the collected information with SPSS 18.0 software,compared gene mutation rate difference between biopsy specimen and pleural effusion cell wax block specimen by the method of X2,P>0.05 means there was no statistically significant in the difference.Results(1)Immunohistochemistry testing result: the expression was almost the same for various immunohistochemical mark of biopsy specimen and cell wax block of the same patient.(2)Mutation testing result of EGFR by ARMS: the mutation rate of biopsy specimen EGFR was 46.7% of 30 patients,among 14 samples EGFR gene mutation specimens,there was 8 samples(68.8%)of 19 exon deletion mutation,6 samples(31.2%)of 21 exon point mutation L858 R,no 18 exon G719 X mutation and 20 exon T790 M mutation.However,the EGFR gene mutation testing positive rate of the corresponding hydrothorax cell wax block was 43.3%(13/30).Among 13 samples EGFR gene mutation specimens,there was 8 samples(61.5%)of 19 exon deletion mutation,5 samples(38.5%)of 21 exon point mutation L858 R,no 18 exon G719 X mutation and 20 exon T790 M mutation.By X2 test with SPSS 18.0 software,it resulted in X2=0.067,P=0.795>0.05.It suggested that it was no statistical significance of EGFR mutation rate difference between biopsy specimen and pleural effusion cell wax block.(P> 0.05)Conclusion(1)The immunohistochemical expression of the experimental group and control group was almost the same,which suggested that cell wax block with immunohistochemistry had important value in lung cancel of pathological diagnosis and typing.(2)There was no statistics difference in EGFR gene mutation rate between the experimental group and control by ARMS method,which suggested that cell wax block could be a specimen source of advanced non-small cell lung cancer test and experimental basis for the targeted treatment of advanced non-small cell lung cancer.