| Objective1.To explore the application of cytology specimens in molecular pathology of lung cancer.2.To explore the feasibility of anaplasitic lymphoma kinase(ALK)immunocytochemistry(ICC)analysis on conventional smears and liquid-based slides of fine needle aspiration cytology(FNAC)in advanced lung adenocarcinoma.Methods1.338 cases of lung cancer which ALK fusion gene were detected using cytology specimens were collected,and the basic information,pathological results,gene detection information,which included ALK,Epidermal Growth Factor Receptor(EGFR),K-RAS,Ros-1,and c-Mesenchymal-Epidermal Transition(c-Met),American Joint Committee on Cancer clinical stages and treatment(Surgery,radiotherapy,chemotherapy,targeted therapy)were summarized.2.147 cases of lymph node metastasis lesions of advanced lung adenocarcinoma,including 100 of liquid-based slides and 47 of conventional smears,are collected in this study.The expression of ALK fusion protein was detected by Roche Ventana ICC technology,compared with the ALK gene fusion assessed by Fluorescence in Situ Hybridization(FISH),reverse transcriptase-polymerase chain reaction(RT-PCR).Results1.In 3 3 8 cases,the positive rate of ALK fusion gene was 9.17%(31/3 3 8),the mutation rate of EGFR and K-RAS was 47.74%(159/333),7.50%(25/333),the fusion rate of Ros-1 was 4%(3/75),the amplification rate of c-Met was 4.11%(3/73).And 276 of 338 cases had been in stage ? B-? at first visit.The positive rate of ALK in the serous cavity effusion was 5.52%(9/163),while in the FNAC specimens was 12.57%(22/175).In 217 cases(64.20%)with genetic alterations,123 cases were targeted therapy.Drug targeting first-line and second-line treatment of patients were 76 47 cases,respectively.10 cases of blind tasting or otherwise choose to eat targeted drugs.2.The positive rate of ALK(D5F3)fusion protein expression in advanced lung adenocarcinoma FNAC was 11.56%(17/147)while in conventional smears and liquid-based cytology reached 10.64%(5/47)and 12.00%(12/100)respectively.Among all 147 cases,there are 57 cases referred to corresponding molecular methods verified,including 17 positive cases and 40 negative cases.The coincidence rate reached 96.49%(55/57)overall,while sensitivity and specificity in ALK(D5F3)fusion protein expression in advanced lung adenocarcinoma FNAC are 94.12%(16/17),97.5%(39/40)respectively.The sensitivity and specificity in conventional smears both reached 100%(5/5 in sensitivity and 10/10 in specificity)while 91.67%(11/12)and 96.67%(29/30)respectively in liquid-based cytology slides.Conclusion1.The patients with advanced(?B-?)lung cancer at the first time or postoperative progressing,the cytology specimen is a reliable source of gene detection.2.The pleura effusion and lymph node FNAC were common specimens in the advanced lung cancer,and ALK fusion genotype were more likely to appear in the cytological specimens compared with the serous cavity effusion,the difference between them were statistically significant.3.Cytological specimens can provide enough cell volume to complete clinical targeted therapy related gene detection.4.Conventional smears and liquid-based cytology in FNAC samples can be used in the detection of ALK(D5F3)ICC analysis of advanced lung adenocarcinoma,especially for those who have no chance in making cell block to perform gene analysis.5.For the application of ALK ICC in liquid-based specimens,the composition of the liquid based cell preservative may lead to the loss of cell surface antigen and often demonstrated heterogeneous expression.It is suggested that FISH test should be carried out when necessary. |
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