Nasser S M, Pitman M B, Pilch B Z, Faquin W C
Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Cancer. 2000 Oct 25;90(5):307-11.
Papillary thyroid carcinoma is the most common malignant neoplasm of the thyroid gland, and fine-needle aspiration biopsy (FNAB) often is the initial diagnostic method used in its detection. Prior studies have shown that immunohistochemical staining for various cytokeratins in general, and cytokeratin 19 (CK19) in particular, can be applied as an ancillary technique for diagnosing papillary thyroid carcinoma in histologic specimens. In the current study the authors assessed the diagnostic utility of CK19 to detect papillary carcinoma effectively in cytologic preparations of thyroid FNABs.
Immunocytochemical staining with CK19 was performed on cytologic aspirates from 37 papillary thyroid carcinomas and 36 other lesions of the thyroid (14 follicular adenomas, 10 multinodular goiters, 5 cases of Hashimoto thyroiditis, 6 oncocytic [Hürthle cell] neoplasms, and 1 follicular carcinoma). All cases included in the study had a corresponding histopathology specimen.
Positive immunocytochemical reactivity for CK19 was identified in 34 of 37 papillary carcinomas and in 1 of 36 other thyroid lesions (sensitivity of 92% and specificity of 97%). Although the strongest reactivity was obtained in methanol fixed thin layer preparations, the antibody also was effective in detecting papillary carcinoma in alcohol fixed and air-dried smears. The single false-positive case was a follicular adenoma with focal areas of papillary hyperplasia. All other aspirates including those from cases of Hashimoto thyroiditis, multinodular goiter, follicular adenoma, oncocytic neoplasms, and follicular carcinoma were negative.
CK19 is an effective, highly sensitive, and specific ancillary tool for the diagnosis of papillary carcinoma in thyroid FNABs.
乳头状甲状腺癌是甲状腺最常见的恶性肿瘤，细针穿刺活检（FNAB）通常是其检测中使用的初始诊断方法。先前的研究表明，一般各种细胞角蛋白的免疫组织化学染色，尤其是细胞角蛋白19（CK19），可作为组织学标本中诊断乳头状甲状腺癌的辅助技术。在本研究中，作者评估了CK19在甲状腺FNAB细胞学标本中有效检测乳头状癌的诊断效用。
对37例乳头状甲状腺癌和36例其他甲状腺病变（14例滤泡性腺瘤、10例结节性甲状腺肿、5例桥本甲状腺炎、6例嗜酸细胞性[许特莱细胞]肿瘤和1例滤泡癌）的细胞学吸出物进行CK19免疫细胞化学染色。研究纳入的所有病例均有相应的组织病理学标本。
37例乳头状癌中有34例CK19免疫细胞化学反应呈阳性，36例其他甲状腺病变中有1例呈阳性（敏感性为92%，特异性为97%）。虽然在甲醇固定的薄层标本中获得了最强的反应性，但该抗体在酒精固定和空气干燥涂片检测乳头状癌中也有效。唯一的假阳性病例是一个伴有局灶性乳头状增生区域的滤泡性腺瘤。所有其他吸出物，包括来自桥本甲状腺炎、结节性甲状腺肿、滤泡性腺瘤、嗜酸细胞性肿瘤和滤泡癌病例的吸出物均为阴性。
CK19是甲状腺FNAB中诊断乳头状癌的一种有效、高度敏感且特异的辅助工具。
