Sturgis C D, Caraway N P, Johnston D A, Sherman S I, Kidd L, Katz R L
Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1999 Jun 25;87(3):155-60. doi: 10.1002/(sici)1097-0142(19990625)87:3<155::aid-cncr9>3.0.co;2-#.
Papillary thyroid carcinoma is the most common thyroid malignancy in the U.S. As many as half of patients with papillary carcinoma present with cervical lymph node metastases at the time of diagnosis. Metastatic disease involving cervical lymph node tissue has not historically been proven to correlate with a more aggressive course; however, distant metastases worsen prognosis.
Diagnostic fine-needle aspiration (FNA) smears from 26 primary and metastatic papillary carcinomas underwent Feulgen reaction and were studied by image analysis to determine DNA pattern, proliferation index, and the percentage of cells with DNA content >5C. The medical records of all the patients were reviewed for metastatic disease pattern and survival data. For metastatic pattern, two groups were defined: 1) confined to thyroid/local lymph node metastases/soft tissues of the neck involved by tumor, and 2) distant metastases.
Among the 26 patients, 16 had "nonaggressive" DNA patterns described as diploid, abnormal diploid, or tetraploid, and 10 had "aggressive" DNA patterns described as aneuploid. Only 2 of the 16 patients in the "nonaggressive" DNA pattern group developed distant metastases, whereas 5 of the 10 patients in the aneuploid group developed distant metastatic disease. In addition, none of the 16 patients with "nonaggressive" DNA patterns died of disease, whereas 3 of the 10 individuals with DNA histograms interpreted as aneuploid did die of metastatic disease complications.
Aneuploidy identified by image analysis of FNA of papillary thyroid carcinoma is significantly associated with death from papillary carcinoma (log rank test, P=0.027).
甲状腺乳头状癌是美国最常见的甲状腺恶性肿瘤。多达一半的乳头状癌患者在诊断时即出现颈部淋巴结转移。历史上尚未证实涉及颈部淋巴结组织的转移性疾病与更具侵袭性的病程相关；然而，远处转移会使预后恶化。
对26例原发性和转移性乳头状癌的诊断性细针穿刺（FNA）涂片进行福尔根反应，并通过图像分析研究以确定DNA模式、增殖指数以及DNA含量>5C的细胞百分比。查阅所有患者的病历以获取转移疾病模式和生存数据。对于转移模式，定义了两组：1）局限于甲状腺/局部淋巴结转移/肿瘤累及的颈部软组织，以及2）远处转移。
在26例患者中，16例具有被描述为二倍体、异常二倍体或四倍体的“非侵袭性”DNA模式，10例具有被描述为非整倍体的“侵袭性”DNA模式。“非侵袭性”DNA模式组的16例患者中只有2例发生远处转移，而非整倍体组的10例患者中有5例发生远处转移性疾病。此外，具有“非侵袭性”DNA模式的16例患者中无一例死于疾病，而DNA直方图被解释为非整倍体的10例患者中有3例死于转移性疾病并发症。
通过甲状腺乳头状癌FNA图像分析确定的非整倍体与乳头状癌死亡显著相关（对数秩检验，P = 0.027）。
