| Objective:Thinprep cytologic test(TCT)combined with Immunocytochemistry(ICC)to study Caudal type homeobox transcription factor 2(CDX2),Villin protein,Paired box gene 8,The expression of PAX 8 and Carbohydrate antigen 125(CA125)in female cancerous ascites,to explore the diagnostic value of various tumor markers and their correlation,and to further explore the value of the combined application of all indicators in the differential diagnosis of primary female cancerous ascites.To provide help for the clinical precision treatment of primary tumor lesions.Methods:A total of 200 female patients with ascites in Shaanxi Provincial People’s Hospital from January 2016 to December 2020 were collected,including 100 benign ascites and 100 cancerous ascites.All the selected cancerous ascites were diagnosed as primary tumor metastatic cancerous ascites by pathological methods such as surgical resection specimens,endoscopic biopsy specimens or peritoneal biopsy specimens.CDX2,Villin protein,PAX8 and CA125 were detected by TCT combined with ICC in all samples.The expression of the above 4 indexes in female cancerous ascites and their relationship with clinicopathological features were studied,and the diagnostic value of the combined detection of the 4 indexes was discussed.Results:CDX2 and PAX8 positive staining sites were located in the nucleus of tumor cells,Villin protein staining sites were located in the cytoplasm of tumor cells,and CA125 staining sites were located in the membrane or cytoplasm of tumor cells.1.The sensitivity and specificity of CDX2 and Viliin in the detection of cancerous ascites from female digestive tract tumors were 55% and 59%,respectively,and 84% and 72%,respectively.The sensitivity and specificity of PAX8 and CA125 in the detection of cancerous ascites from ovarian cancer were 83% and 94%,respectively,and 88% and 60%,respectively.CDX2,Villin protein,PAX8 and CA125 had no positive expression in female benign ascites.2.The positive rates of CDX2 in cancerous ascites from gastric cancer,colorectal cancer and pancreatic cancer were 63.63%,60.00% and 50.00%,respectively,while no positive expression was found in cancerous ascites from ovarian cancer and lung cancer.There was no statistical difference in its expression in cancerous ascites from various digestive tract tumors(P>0.05),but there was statistical difference in its expression in cancerous ascites from digestive tract tumors and non-digestive tract tumors(ovarian cancer and lung cancer)(P<0.01).3.Villin protein was expressed in gastric cancer,colorectal cancer,pancreatic cancer,appendix cancer and ovarian cancer in cancerous ascites,with positive rates of55.56%,66.67%,60.00% and 8.33%,respectively.However,no positive expression was found in cancerous ascites from lung cancer.There was no statistical difference in its expression in cancerous ascites from various digestive tract tumors(P>0.05),but there was statistical difference in its expression in cancerous ascites from digestive tract tumors and non-digestive tract tumors(ovarian cancer and lung cancer)(P <0.01).4.PAX8 was expressed in cancerous ascites from ovarian cancer and endometrial cancer,with a positive rate of 82.87% and 100%,respectively.However,no positive expression was found in cancerous ascites from gastric cancer,pancreatic cancer and lung cancer.There was a significant difference in the expression between the female reproductive system sources and non-female reproductive system sources(P<0.01).5.CA125 was expressed in cancerous ascites from ovarian cancer,endometrial cancer and pancreatic cancer,with a positive rate of 82.87%,100% and 50.00%,respectively.However,no positive expression was found in cancerous ascites from gastric cancer and lung cancer.There was no statistically significant difference in the expression of CA125 in ovarian cancer,endometrial cancer and pancreatic cancer-derived ascites(P>0.05),but there was statistically significant difference in the expression of CA125 in ovarian cancer,gastric cancer and lung cancer derived ascites(P<0.05).6.There was a significant correlation between the expression of CDX2 and Villin protein in cancerous ascites of female digestive tract tumors(rs=0.807,P <0.01).There was no correlation between the expression of PAX8 and CA125 in female ovarian cancer-derived ascites(rs=0.369,P>0.05).7.Compared with the gold standard of pathology,CDX2 detection showed moderate consistency(Kappa =0.403)and Villin protein detection showed weak consistency(Kappa =0.289).CDX2 was better than Villin protein in the diagnosis of cancerous ascites from gastrointestinal tumors in women.PAX8 was moderately consistent in the diagnosis of cancerous ascites from ovarian cancer in women(Kappa value =0.567),and CA125 was moderately consistent in the diagnosis of cancerous ascites from ovarian cancer in women(Kappa value =0.538).PAX8 was better than CA125 in the diagnosis of cancer ascites from ovarian cancer in women.8.When CDX2,Villin protein,PAX8,and CA125 were combined to detect the source of primary cancerous ascites in women,the sensitivity reached 91% under the premise of maintaining high specificity(70%),which was superior to any single marker detection.Conclusion:1.CDX2 and Villin proteins are specific markers of cancerous ascites derived from digestive tract tumors.2.PAX8 suggested cancerous ascites of female reproductive system,and the positive expression of CA125 more suggested cancerous ascites of ovarian cancer.3.There was a significant correlation between the expression of CDX2 and Villin protein in female cancerous ascites,while there was no correlation between PAX8 and CA125.4.CDX2 has a better diagnostic value than Villin protein in the diagnosis of cancerous ascites from digestive tract in women,and PAX8 has a better diagnostic value than CA12 in the diagnosis of cancerous ascites from ovarian cancer in women.5.The combination of CDX2,Villin,PAX8,and CA125 is superior to any single marker test in diagnosing the primary source of cancerous ascites in women. |
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