CK19和TPO在甲状腺细针穿刺Bethesda Ⅲ类结节组织中的表达及临床意义
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摘要
目的:探讨细胞角蛋白19(CK19)、甲状腺过氧化物酶(TPO)在甲状腺细针穿刺(FNA) BethesdaⅢ类结节组织中的表达情况及临床意义。方法:对156例细胞学为BethesdaⅢ类且有组织病理学诊断的甲状腺FNA标本进行沉渣包埋切片,采用En Vision法检测CK19及TPO在沉渣包埋切片中的表达情况。结果:术后组织病理学确诊为甲状腺乳头状癌(papillary thyroid carcinoma,PTC) 95例,良性病变61例,包括结节性甲状腺肿(nodular goiter,NG) 33例,滤泡性腺瘤(follicular adenoma,FA) 24例,淋巴细胞甲状腺炎(lymphocytic thyroiditis,LT) 4例。免疫细胞化学检测CK19在PTC中明显高表达,阳性表达率为98. 95%,敏感度为98. 95%,特异度为85. 25%; TPO在PTC中明显阴性表达,阴性表达率为93. 68%,敏感度为93. 68%,特异度为96. 72%;两种抗体在PTC中联合表达的阳性率为98. 95%,敏感度为98. 95%,特异度为100. 00%。PTC中CK19阳性表达率及TPO阴性表达率显著高于良性病变(P <0. 01),两种抗体联合表达率在PTC与良性病变间的差异具有统计学意义(P <0. 01)。结论:CK19和TPO联合检测有助于甲状腺FNA BethesdaⅢ类结节组织中PTC与良性病变的鉴别诊断。
Objective: To explore the expression and clinical significance of detecting CK19 and TPO in BethesdaⅢ of thyroid fine needle aspiration( FNA). Methods: 156 cases of thyroid FNA specimens with cytology of BethesdaⅢ and histopathological diagnosis were carried out of sediment embedding slice,and the expression of CK19 and TPO were detected by the method of En Vision in the ediment embedding slice. Results: 95 cases were diagnosed with papillary thyroid carcinoma( PTC) by postoperative histopathology,and 61 cases were benign lesion,including 33 cases of nodular goiter( NG),24 cases of follicular adenoma( FA) and 4 cases of lymphocytic thyroiditis( LT). Immunocytochemistry detection showed that CK19 was highly expressed in PTC,with a positive rate of 98. 95%,and the sensitivity and specificity were 98. 95% and 85. 25% respectively. TPO was negatively expressed in PTC,with a negative expression rate of 93. 68%,and the sensitivity and specificity were 93. 68% and 96. 72% respectively. The two antibodies were combined expressed in PTC with a positive rate of 9 8. 9 5 %,and the sensitivity and specificity were98. 95% and 100. 00% respectively. The positive expression rate of CK19 and negative expression rate of TPO were significantly higher in PTC than benign lesion( P < 0. 01). The combined expression of this two antibodie was statistically different between PTC and benign lesion( P < 0. 01). Conclusion: The combined detection of CK19 and TPO is more helpful for the differential diagnosis of PTC and benign lesions in Bethesda Ⅲ of thyroid FNA.
Objective: To explore the expression and clinical significance of detecting CK19 and TPO in BethesdaⅢ of thyroid fine needle aspiration( FNA). Methods: 156 cases of thyroid FNA specimens with cytology of BethesdaⅢ and histopathological diagnosis were carried out of sediment embedding slice,and the expression of CK19 and TPO were detected by the method of En Vision in the ediment embedding slice. Results: 95 cases were diagnosed with papillary thyroid carcinoma( PTC) by postoperative histopathology,and 61 cases were benign lesion,including 33 cases of nodular goiter( NG),24 cases of follicular adenoma( FA) and 4 cases of lymphocytic thyroiditis( LT). Immunocytochemistry detection showed that CK19 was highly expressed in PTC,with a positive rate of 98. 95%,and the sensitivity and specificity were 98. 95% and 85. 25% respectively. TPO was negatively expressed in PTC,with a negative expression rate of 93. 68%,and the sensitivity and specificity were 93. 68% and 96. 72% respectively. The two antibodies were combined expressed in PTC with a positive rate of 9 8. 9 5 %,and the sensitivity and specificity were98. 95% and 100. 00% respectively. The positive expression rate of CK19 and negative expression rate of TPO were significantly higher in PTC than benign lesion( P < 0. 01). The combined expression of this two antibodie was statistically different between PTC and benign lesion( P < 0. 01). Conclusion: The combined detection of CK19 and TPO is more helpful for the differential diagnosis of PTC and benign lesions in Bethesda Ⅲ of thyroid FNA.
引文
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[12] Wang LQ,Peng GL,Jiang M. Expression and clinical significance of thyroid peroxidase and galactoagglutinin-3 in thyroid micropapillary carcinoma[J]. Chin J Experimental Surg,2016,33(1):205-207.
[13] Nan RL,Shang PZ,Gu HP,et al. Expression and significance of galactoagglutinin-3,cytokeratin-19 and thyroid peroxidase in thyroid papillary carcinoma[J]. Chinese Journal of Clinicians(Electronic Edition),2013,7(6):2381-2384.
[14] Bose D,Das RN,Chatterjee U,et al. Cytokeratin 19 immunoreactivity in the diagnosis of papillary thyroid carcinoma[J]. Indian J Med Pae diatr Oncol,2012,33(2):107-111.
[15] Yu WY,Wang SY,Wang HP,et al. Differential diagnosis of 34βE12,CK19 and TPO in thyroid papillary carcinoma and thyroid papillary hyperplasia[J]. Zhejiang Practical Medicine,2012,17(2):88-89.[俞文英,王淑妍,王海萍,等. 34βE12、CK19与TPO在甲状腺乳头状癌与甲状腺乳头状增生鉴别诊断中的价值[J].浙江实用医学,2012,17(2):88-89.]
[16] Cipollini M,Pastor S,Gemignani F,et al. TPO genetic variants and risk of differentiated thyroid carcinoma in two European populations[J]. Int J Cancer,2013,133(12):2843-2851.
[17] Xi M,Hu XY,Zheng L,et al. Diagnostic value of TPO,CD56 and GPC-3 expression in thyroid papillary carcinoma[J]. Journal of Anhui Medical University,2016,51(10):1539-1542.[席民,胡向阳,郑丽,等. TPO、CD56和GPC-3表达在甲状腺乳头状癌中的诊断价值[J].安徽医科大学学报,2016,51(10):1539-1542.]
[18] Savin S,Cvejic D,Isic T,et al. Thyroid peroxidase and galectin-3 immunostaining in differentiated thyroid carcinoma with clinicopathologic correlation[J]. Human Pathology,2008,39(11):1656-1663.
[19] Xu J,Ding XB,Xiao GX. Expression levels and diagnostic value of CK19,TPO,galectin-3 and Survivin proteins in thyroid micropapillary carcinoma tissues[J]. Chinese Journal of PLA Medicine,2017,29(6):48-50.[许军,丁旭贝,肖光雄.甲状腺微小乳头状癌组织中CK19、TPO、Galectin-3和Survivin蛋白表达水平及诊断价值[J].解放军医药杂志,2017,29(6):48-50.]
[2] Rossi ED,Raffaelli M,Zannoni GF,et al. Diagnostic efficacy of conventional as compared to liquid-based cytology in thyroid lesions evaluation of 10 360 fine needle aspiration cytology cases[J]. Acta Cytologica,2009,53(6):659-666.
[3] Rong R,Wu Y,Yao Q,et al. Cytopathological analysis of 2 043 cases of thyroid fine needle aspiration[J]. Chin J Pathol,2016,45(6):368-371.[戎荣,吴妍,姚青,等.甲状腺细针穿刺检查2043例细胞病理学分析[J].中华病理学杂志,2016,45(6):368-371.]
[4] Kang X,Duan Y. The value of lippl liquid-based cytology combined with immunocytochemistry in the diagnosis of thyroid nodules by fine needle aspiration[J]. Journal of Nanjing Medical University(Natural Science Edition),2015,33(4):561-563,566.[康璇,段宇.利普液基细胞学联合免疫细胞化学在细针穿刺诊断甲状腺结节中的价值[J].南京医科大学学报(自然科学版),2015,33(4):561-563,566.]
[5] Aji SZ,Cibas ES. The bethesda system for reporting thyroid cytopathology:Definitions,criteria and explanatory notes[M]. New York:Springer,2010:1-2.
[6] Rabaglia JL,Kabbani W,Wallace L,et al. Effect of the bethesda system for reporting thyroid cytopathology on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions[J]. Surgery,2010,148(6):1267-1273.
[7] Zhang XF,Liu ZY. 2018 edition of thyroid fine needle biopsy cytopathology Bethesda report system interpretation[J]. Chin J Pathol,2018,47(9):729-732.[张晓芳,刘志艳. 2018版甲状腺细针穿刺活检细胞病理学Bethesda报告系统解读[J].中华病理学杂志,2018,47(9):729-732.]
[8] Kakudo K,Higuchi M,Hirokawa M,et al. Thyroid FNA cytology in Asian practice-Active surveillance for indeterminate thyroid nodules reduces overtreatment of thyroid carcinomas[J]. Cytopathology,2017,28(6):455-466.
[9] Cibas ES,Ali SZ. The 2017 bethesda system for reporting thyroid cytopathology[J]. Thyroid,2017,27(11):1341-1346.
[10] Lin JL,Zhong GD,Wang HC,et al. Pathological diagnosis and analysis of 2 386 cases of thyroid fine needle aspiration liquidbased cytology[J]. Journal of Diagnostic Pathology,2018,25(2):112-117.[林建龙,钟国栋,王鸿程,等. 2 386例甲状腺细针穿刺液基细胞学病理诊断分析[J].诊断病理学杂志,2018,25(2):112-117.]
[11] Wu LH. Application of fine needle aspiration combined with immunocytochemistry in the diagnosis of thyroid papillary lesions[J]. Chinese Experimental Diagnostics,2014,18(7):1084-1086.[吴丽华.常规细针穿刺联合免疫细胞化学在甲状腺乳头状病变诊断中的应用[J].中国实验诊断学,2014,18(7):1084-1086.]
[12] Wang LQ,Peng GL,Jiang M. Expression and clinical significance of thyroid peroxidase and galactoagglutinin-3 in thyroid micropapillary carcinoma[J]. Chin J Experimental Surg,2016,33(1):205-207.
[13] Nan RL,Shang PZ,Gu HP,et al. Expression and significance of galactoagglutinin-3,cytokeratin-19 and thyroid peroxidase in thyroid papillary carcinoma[J]. Chinese Journal of Clinicians(Electronic Edition),2013,7(6):2381-2384.
[14] Bose D,Das RN,Chatterjee U,et al. Cytokeratin 19 immunoreactivity in the diagnosis of papillary thyroid carcinoma[J]. Indian J Med Pae diatr Oncol,2012,33(2):107-111.
[15] Yu WY,Wang SY,Wang HP,et al. Differential diagnosis of 34βE12,CK19 and TPO in thyroid papillary carcinoma and thyroid papillary hyperplasia[J]. Zhejiang Practical Medicine,2012,17(2):88-89.[俞文英,王淑妍,王海萍,等. 34βE12、CK19与TPO在甲状腺乳头状癌与甲状腺乳头状增生鉴别诊断中的价值[J].浙江实用医学,2012,17(2):88-89.]
[16] Cipollini M,Pastor S,Gemignani F,et al. TPO genetic variants and risk of differentiated thyroid carcinoma in two European populations[J]. Int J Cancer,2013,133(12):2843-2851.
[17] Xi M,Hu XY,Zheng L,et al. Diagnostic value of TPO,CD56 and GPC-3 expression in thyroid papillary carcinoma[J]. Journal of Anhui Medical University,2016,51(10):1539-1542.[席民,胡向阳,郑丽,等. TPO、CD56和GPC-3表达在甲状腺乳头状癌中的诊断价值[J].安徽医科大学学报,2016,51(10):1539-1542.]
[18] Savin S,Cvejic D,Isic T,et al. Thyroid peroxidase and galectin-3 immunostaining in differentiated thyroid carcinoma with clinicopathologic correlation[J]. Human Pathology,2008,39(11):1656-1663.
[19] Xu J,Ding XB,Xiao GX. Expression levels and diagnostic value of CK19,TPO,galectin-3 and Survivin proteins in thyroid micropapillary carcinoma tissues[J]. Chinese Journal of PLA Medicine,2017,29(6):48-50.[许军,丁旭贝,肖光雄.甲状腺微小乳头状癌组织中CK19、TPO、Galectin-3和Survivin蛋白表达水平及诊断价值[J].解放军医药杂志,2017,29(6):48-50.]