Bartolazzi A, Gasbarri A, Papotti M, Bussolati G, Lucante T, Khan A, Inohara H, Marandino F, Orlandi F, Nardi F, Vecchione A, Tecce R, Larsson O
Department of Oncology-Pathology, Cellular and Molecular Tumor Pathology, Cancer Center Karolinska, CCK R8:04 Karolinska Hospital, 17176, Stockholm, Sweden.
Lancet. 2001 May 26;357(9269):1644-50. doi: 10.1016/s0140-6736(00)04817-0.
Thyroid cancer is the most common endocrine malignant disease, but preoperative diagnosis remains a challenge. Fine-needle aspiration cytology has greatly improved the clinical management of thyroid nodules, but the preoperative characterisation of follicular lesions is very difficult. Many patients are thus referred to surgery more for diagnosis than for therapeutic necessity. We undertook an international multicentre study to assess the usefulness of immunohistocytochemical staining for two potential markers of malignant thyrocytes.
Expression of galectin-3 and CD44v6 was tested on 1009 thyroid lesions (tissue specimens and cytological cell-blocks) and 226 fresh cytological samples obtained preoperatively by ultrasound-guided fine-needle aspiration of thyroid nodules (prospective analysis). The test used monoclonal antibodies specific for CD44v6 and galectin-3, the indirect avidin-biotin complex immunoperoxidase method, and 3-amino-9-ethyl-carbazole as substrate.
The sensitivity, specificity, positive predictive value, and diagnostic accuracy of this test method (for coexpression of the two markers) in the prospective analysis were 88%, 98%, 91%, and 97%, respectively. The sensitivity and specificity of galectin-3 immunodetection alone in discriminating benign from malignant thyroid lesions were more than 99% and 98% respectively, and the positive predictive value and diagnostic accuracy were 92% and 99%.
The integration of galectin-3 immunostaining with conventional cytomorphological and clinical diagnostic procedures represents a sensitive and reliable diagnostic approach for preoperative identification of thyroid carcinomas. This test method improves the diagnostic accuracy of conventional cytology and provides the molecular basis for a new nosological assignation of the not yet classified thyroid neoplasms of indeterminate malignant behaviour.
甲状腺癌是最常见的内分泌恶性疾病，但术前诊断仍然是一项挑战。细针穿刺细胞学检查极大地改善了甲状腺结节的临床管理，但滤泡性病变的术前特征描述非常困难。因此，许多患者接受手术更多是为了诊断而非治疗需要。我们开展了一项国际多中心研究，以评估免疫细胞化学染色对两种潜在甲状腺癌细胞标志物的效用。
对1009例甲状腺病变（组织标本和细胞学细胞块）以及226例术前通过超声引导下甲状腺结节细针穿刺获得的新鲜细胞学样本进行了半乳糖凝集素-3和CD44v6表达检测（前瞻性分析）。该检测使用针对CD44v6和半乳糖凝集素-3的单克隆抗体、间接抗生物素蛋白-生物素复合物免疫过氧化物酶法，并以3-氨基-9-乙基咔唑作为底物。
在前瞻性分析中，该检测方法（针对两种标志物的共表达）的敏感性、特异性、阳性预测值和诊断准确性分别为88%、98%、91%和97%。单独进行半乳糖凝集素-3免疫检测以区分甲状腺良性与恶性病变时，其敏感性和特异性分别超过99%和98%，阳性预测值和诊断准确性分别为92%和99%。
将半乳糖凝集素-3免疫染色与传统细胞形态学和临床诊断程序相结合，是术前识别甲状腺癌的一种敏感且可靠的诊断方法。该检测方法提高了传统细胞学的诊断准确性，并为尚未分类的具有不确定恶性行为的甲状腺肿瘤的新分类提供了分子基础。
