本文選題：非小細胞肺癌 + 熒光原位雜交�。� 參考：《天津醫(yī)科大學》2015年碩士論文

【摘要】：研究目的本研究創(chuàng)新性應用熒光原位雜交(FISH)技術(shù)檢測非小細胞肺癌(NSCLC)患者現(xiàn)場細胞學(ROSE)制片的表皮生長因子受體(EGFR)基因擴增狀態(tài),旨在探討以NSCLC患者氣管鏡取得細胞學或組織塊標本的ROSE制片為標本,FISH檢測其EGFR基因擴增狀態(tài)的應用。以及探討EGFR基因擴增狀態(tài)在NSCLC患者中與其年齡、性別、吸煙狀態(tài)、病理類型、分化程度、腫瘤TNM分期等臨床特征的相關(guān)性。研究方法本研究在2013年9月至2014年12月期間對就診于天津醫(yī)科大學總醫(yī)院呼吸內(nèi)科氣管鏡室且胸部X線或CT檢查懷疑肺部惡性腫瘤性病變而行診斷性治療的患者在氣管鏡檢查過程中予以ROSE制片指導其進行程度。然后應用FISH技術(shù)在原ROSE制片上檢測71例最終取材經(jīng)過病理科醫(yī)師細胞學或組織學確診為NSCLC患者的EGFR基因擴增狀態(tài),并將FISH結(jié)果與患者臨床特征進行統(tǒng)計學比較。其數(shù)據(jù)結(jié)果應用SPSS16.0統(tǒng)計軟件處理,P0.05視為差異具有統(tǒng)計學意義。結(jié)果1.在本研究中ROSE惡性細胞陽性并且考慮NSCLC的72例患者僅有3例因取材量小而未得到病理科確診,病理報告1例為未找到腫瘤細胞,另外2例為可見可疑核異質(zhì)細胞;另有2例現(xiàn)場ROSE惡性細胞陽性但觀察形態(tài)考慮為小細胞肺癌(SCLC)的患者最終經(jīng)病理科確診病理類型為低分化鱗癌;本研究中ROSE對NSCLC患者制片中惡性細胞的現(xiàn)場診斷與最終病理確診的符合率可達95.9%,且研究進行期間ROSE診斷未出現(xiàn)假陰性的結(jié)果;最終共搜集NSCLC患者ROSE制片71例行FISH檢測,其中有68例(95.8%)患者順利取得結(jié)果,另外3例患者ROSE制片分別因為1例細胞數(shù)目過少、1例細胞重疊過多影響信號讀取與1例雜交后出現(xiàn)部分區(qū)域無雜交信號及部分區(qū)域雜交率較低而導致FISH檢測的失敗。2.其EGFR基因發(fā)生擴增,即FISH(+)的患者共23例,其中7例為簇狀擴增。EGFR基因擴增率為33.8%。并且經(jīng)過統(tǒng)計學分析,EGFR基因擴增狀態(tài)與患者性別(χ2=0.176,P=0.675)、年齡(χ2=2.796,P=0.094)、吸煙狀態(tài)(χ2=0.584,P=0.445)、病理類型(χ2=1.248,P=0.264)、腫瘤分化程度(χ2=1.234,P=0.267)、腫瘤TNM分期(P=0.474)的統(tǒng)計結(jié)果均無明顯統(tǒng)計學差異(P均0.05)。結(jié)論本研究搜集NSCLC患者ROSE制片,創(chuàng)新性的應用FISH技術(shù)在ROSE制片的原片上進行EGFR基因擴增的檢測,研究結(jié)果表明:1.NSCLC患者氣管鏡細胞學及組織塊標本的ROSE閱片結(jié)果與最終診斷結(jié)果一致性良好,并且FISH技術(shù)可應用于ROSE制片作為標本來檢測EGFR基因的擴增狀態(tài),此方法不僅使得細胞學的FISH研究更加科學、嚴謹;而且較傳統(tǒng)方法更加快捷、經(jīng)濟。但應注意提高氣管鏡室ROSE制片的質(zhì)量,因為其質(zhì)量可直接影響氣管鏡檢查的進度及FISH結(jié)果的取得。FISH結(jié)果的順利取得還需在進行過程中注意雜交區(qū)域的正確選擇、水浴與消化等步驟的適度等。2.本研究中NSCLC患者的EGFR基因擴增率為33.8%,且其在不同性別、不同年齡、不同吸煙狀態(tài)、不同病理類型、不同腫瘤分化程度、不同TNM分期中不存在明顯的差異,即未發(fā)現(xiàn)NSCLC患者的EGFR基因擴增狀態(tài)與臨床特征的顯著相關(guān)性。
[Abstract]:The purpose of this study was to detect the amplification state of epidermal growth factor receptor (EGFR) gene in the field cytology (ROSE) of non small cell lung cancer (NSCLC) patients by innovative application of fluorescence in situ hybridization (FISH). The purpose of this study was to explore the ROSE filmmaking of cytology or tissue specimens obtained from the trachea of NSCLC patients as specimens. FISH was used to detect the expansion of the EGFR gene. The correlation of EGFR gene amplification status in NSCLC patients with age, sex, smoking status, pathological type, degree of differentiation, TNM staging, and other clinical features. The study was conducted in the trachea room of the respiratory department of General Hospital Affiliated to Tianjin Medical University during the period from September 2013 to December 2014. The X-ray or CT examination of the patients who suspected pulmonary malignant tumor and diagnostic treatment were guided by ROSE in the process of tracheal endoscopy. Then, the FISH technique was used to detect the EGFR gene amplification status of 71 cases in the original ROSE film, which were determined by the cytology or histology of the pathologist. The results of FISH were compared with the clinical features of the patients. The results of the data were treated with SPSS16.0 software, and P0.05 was statistically significant. Results 1. in this study, only 3 cases of ROSE malignant cells and 72 patients considering NSCLC were not confirmed by the pathology department, and 1 cases were not reported. The tumor cells were found, the other 2 cases were suspicious nuclear heterocells, and 2 cases of ROSE malignant cells were positive but the patients with small cell lung cancer (SCLC) were diagnosed as a low differentiated squamous cell carcinoma. In this study, the field diagnosis and final pathological diagnosis of the malignant cells in the NSCLC patients were in the field and in the final pathological diagnosis. The coincidence rate reached 95.9%, and the results of ROSE diagnosis during the study did not appear false negative; finally, a total of 71 cases of ROSE production in NSCLC patients were detected by FISH, of which 68 cases (95.8%) were successfully obtained, and the other 3 cases of ROSE produced 1 cases with small number of cells, 1 cells overlapped overoverlapping signal reading and 1 hybrids. There were no hybridization signals in some regions and low hybridization rates in some regions that resulted in the failure of FISH detection in.2.. The EGFR gene was amplified, that is, 23 cases of FISH (+), of which 7 cases were amplified by cluster amplification of.EGFR gene amplification rate of 33.8%. and statistically analyzed, EGFR gene expansion and patient sex (chi 2=0.176, P=0.675), age (x 2=2). .796, P=0.094), smoking status (x 2=0.584, P=0.445), pathological type (x 2=1.248, P=0.264), the degree of tumor differentiation (2=1.234, P=0.267), and the statistical results of the tumor TNM staging (P=0.474) were not statistically significant (P all 0.05). The results of gene amplification test showed that the results of ROSE scanning in trachea and tissue specimens of 1.NSCLC patients were in good agreement with the final diagnosis, and the FISH technique could be used as a specimen to detect the amplification state of EGFR gene. This method not only made the FISH research of cytology more scientific and rigorous. It is more rapid and economical than the traditional method. However, attention should be paid to improving the quality of ROSE filmmaking in the trachea room, because the quality of the trachea can directly affect the progress of the trachea and the results of the FISH result in the smooth acquisition of the.FISH results. It is necessary to pay attention to the correct selection of the hybridization area in the process, and in the moderate.2. study of the steps of water bath and digestion. The amplification rate of EGFR gene in NSCLC patients was 33.8%, and there was no significant difference in different sex, different age, different smoking status, different pathological types, different degree of differentiation of tumor and different TNM staging, that is, no significant correlation was found between the amplification state of EGFR gene and clinical characteristics in NSCLC patients.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R734.2

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