Department of Pathology and Cytopathology, Lariboisière Hospital, Paris, France.
Thyroid. 2011 Oct;21(10):1067-73. doi: 10.1089/thy.2011.0014. Epub 2011 Aug 29.
Thyroid nodules are relatively common (7% of the population) but are malignant in only 5%-10% of cases. Fine-needle aspiration (FNA) to detect cancer can have > 90% sensitivity but only 50%-65% specificity because of false-positive results, which necessitates surgical controls. We aimed to assess the diagnostic accuracy of immunocytochemistry (ICC) of thyroid FNA to improve its sensitivity and specificity.
We prospectively collected 2038 thyroid FNAs, of which 1397 were FNA biopsies with liquid-based cytology (Thin-Prep-Hologic®). ICC with cytokeratin 19 and HBME1 antibodies (Dako® A/S) was used for all malignant cases and cases of atypical cells of undetermined significance (AUS), follicular neoplasm (FN), and nodules suspicious for malignancy-papillary thyroid carcinoma (SM-PTC) as well as some benign cases (abnormal features on radiography or benign on secondary FNA). ICC results were defined as "non-contributory," "favoring benign," "favoring malignant," or "indeterminate." Results for 150 cases were compared with histological controls for diagnostic accuracy.
Of these 150 cases ICC was helpful for benign or malignant triage of 48 cases of AUS, FN, and SM-PTC (42% of these lesions). Six (4%) ICC results were false positive (favoring malignant with benign histology) but none were false negative (favoring benign with malignant histology). Results for indeterminate cytological cases favored malignant or benign disease with sensitivity, specificity, and negative and positive predictive values of 100%, 85.2%, 100%, and 86.2%, respectively.
ICC of thyroid FNAs with cytokeratin 19 and HBME1 antibodies can reduce the false-positive and false-negative results of single morphological analyses. It can increase the sensitivity and specificity of diagnosis, thus improving diagnostic accuracy and reducing the need for surgical controls.
甲状腺结节较为常见（占人群的 7%），但恶性肿瘤仅占 5%-10%。细针抽吸（FNA）检测癌症的敏感度>90%，但特异度仅为 50%-65%，因为存在假阳性结果，需要手术控制。我们旨在评估免疫细胞化学（ICC）在甲状腺 FNA 中的诊断准确性，以提高其敏感度和特异度。
我们前瞻性收集了 2038 例甲状腺 FNA，其中 1397 例为液体基细胞学（Thin-Prep-Hologic®）的 FNA 活检。所有恶性病例、不典型细胞意义未明（AUS）、滤泡性肿瘤（FN）和可疑恶性的结节-甲状腺乳头状癌（SM-PTC）以及一些良性病例（影像学异常或二次 FNA 为良性）均使用角蛋白 19 和 HBME1 抗体的 ICC（Dako® A/S）。ICC 结果定义为“无意义”、“倾向良性”、“倾向恶性”或“不确定”。对 150 例病例的结果与组织学对照进行诊断准确性比较。
在这 150 例病例中，ICC 有助于对 48 例 AUS、FN 和 SM-PTC 病例进行良性或恶性分类（这些病变中的 42%）。6 例（4%）ICC 结果为假阳性（倾向恶性而组织学为良性），但无一例为假阴性（倾向良性而组织学为恶性）。对于不确定的细胞学病例，ICC 结果对恶性或良性疾病的敏感度、特异度、阴性和阳性预测值分别为 100%、85.2%、100%和 86.2%。
甲状腺 FNA 的角蛋白 19 和 HBME1 抗体 ICC 可减少单一形态学分析的假阳性和假阴性结果。它可以提高诊断的敏感度和特异度，从而提高诊断准确性，减少手术控制的需要。
