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目的评估荧光原位杂交(flunorescence in situ hybridization,FISH)技术在检测胃癌标本中HER2基因扩增的应用价值。方法收集2010年1月—2012年11月经手术切除,病理证实为胃腺癌的标本325例。术前均未行化疗和放疗。所有标本均经10%中性福尔马林固定,常规脱水,石蜡包埋,切片厚3～5μm。分别采用免疫组织化学(immunohis to chemistry,IHC)和FISH两种方法,检测325例胃癌中HER2蛋白表达及HER2基因扩增的情况。结果 325例胃癌IHC检测结果显示HER(+++)25例,阳性率为7.69%,HER2(++)31例(9.54%),HER2(+)61例(18.77%),HER2(0)208例(64.0%)。FISH检测结果显示325例胃癌中HER2基因扩增48例(14.77%),其中25例HER2(+++)病例中,23例存在HER2基因扩增,符合率92%;31例HER2(++)病例中13例存在HER2基因扩增(41.9%);61例HER2(+)病例中5例存在HER2基因扩增(8.19%);208例HER2(-)病例中7例存在HER2基因扩增(3.37%)。结论胃癌HER2基因扩增阳性率明显高于HER2蛋白表达阳性率;IHC可作为初步筛查胃癌HER2状态的首选方法;对于晚期胃癌患者有必要进一步行FISH检测,确定HER2基因状态,指导临床选择靶向治疗。
Objective To evaluate the value of fluorescence in situ hybridization (FISH) in the detection of HER2 gene amplification in gastric cancer specimens. Methods A total of 325 specimens of gastric adenocarcinoma were collected from January 2010 to November 2012 after surgical resection. No preoperative chemotherapy and radiotherapy. All specimens were fixed in 10% neutral formalin, dehydrated routinely, embedded in paraffin, sliced 3 ~ 5μm thick. Immunohistochemistry (IHC) and FISH were used to detect HER2 protein expression and HER2 gene amplification in 325 cases of gastric cancer. Results The IHC results of 325 cases of gastric cancer showed 25 cases of HER (+++), the positive rate was 7.69%, 31 cases of HER2 (++) (9.54%), HER2 (61.7% 208 cases (64.0%). The FISH results showed HER2 gene amplification in 48 cases (14.77%) of 325 cases of gastric cancer, of which 25 cases of HER2 (+++) cases, HER2 gene amplification in 23 cases, the coincidence rate of 92%; 31 cases of HER2 (++ ) HER2 gene amplification was present in 13 cases (41.9%); HER2 gene amplification was present in 5 of 61 HER2 (+) cases (8.19%); HER2 gene amplification was present in 7 of 208 HER2 (-) cases (3.37%). Conclusions The positive rate of HER2 gene amplification in gastric cancer is significantly higher than that of HER2 protein expression. IHC may be the first choice for screening HER2 in gastric cancer. FISH detection should be performed in patients with advanced gastric cancer to determine HER2 gene status and guide clinical choice of target To treatment.