Abd El Atti Rasha M, Shash Lobna S
Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Egypt Natl Canc Inst. 2012 Dec;24(4):175-84. doi: 10.1016/j.jnci.2012.10.002. Epub 2012 Nov 6.
The pathological diagnosis of papillary thyroid carcinoma (PTC) is usually easily achieved. However distinguishing the follicular variant of papillary carcinoma (FVPC) from other follicular thyroid lesions is an area of controversy. In this study we investigated the role of CD56 and claudin-1 in discriminating the FVPCs from other solitary follicular patterned nodules. We also evaluated the application of these two markers in reclassifying the controversial cases of the well differentiated tumors of unknown malignant potential (WDTs-UMP).
The immunohistochemical expression of CD56 and claudin-1 was evaluated in 86 samples of thyroid lesions together with 10 samples of normal thyroid tissue. Thyroid lesions included: 29 PTCs [classic papillary carcinoma (n = 13) and FVPC (n = 16)], 47 solitary follicular patterned nodules [follicular adenomas (n = 12), hyperplastic nodules (n = 32) and follicular tumor of unknown malignant potential (n = 3)] and 10 WDTs-UMP.
The statistical analysis showed significantly different expressions of each of CD56 and claudin-1 in the FVPCs versus other solitary follicular patterned nodules. Claudin-1 sensitivity (100%) was higher than CD56 sensitivity (81.3%). However claudin-1 specificity (80.9%) was < CD56 specificity (89.4%). The combined use of CD56 and claudin-1(claudin-1 + /CD56-) showed specificity (100%), positive predictive value (100%) and sensitivity (81.3%) in the differentiation between the FVPCs and other follicular nodules. In the light of this statistical outcome, 5/10 cases of WDTs-UMP expressing the (claudin-1 + /CD56-) panel could be rediagnosed as PTC.
Combined utility of CD56 and claudin-1 is helpful in diagnosing the FVPC and its differentiation from other follicular patterned nodules. Application of these two markers may greatly aid in the reevaluation of the WDTs-UMP and interpretation of their expected behavior.
甲状腺乳头状癌（PTC）的病理诊断通常较容易实现。然而，鉴别乳头状癌的滤泡状变异型（FVPC）与其他滤泡性甲状腺病变是一个存在争议的领域。在本研究中，我们调查了CD56和claudin-1在鉴别FVPC与其他孤立性滤泡样结节中的作用。我们还评估了这两种标志物在重新分类具有未知恶性潜能的高分化肿瘤（WDTs-UMP）的争议病例中的应用。
评估了86例甲状腺病变样本以及10例正常甲状腺组织样本中CD56和claudin-1的免疫组化表达。甲状腺病变包括：29例PTC[经典乳头状癌（n = 13）和FVPC（n = 16）]、47例孤立性滤泡样结节[滤泡性腺瘤（n = 12）、增生性结节（n = 32）和具有未知恶性潜能的滤泡性肿瘤（n = 3）]以及10例WDTs-UMP。
统计分析显示，FVPC与其他孤立性滤泡样结节相比，CD56和claudin-1的表达均有显著差异。Claudin-1的敏感性（100%）高于CD56的敏感性（81.3%）。然而，claudin-1的特异性（80.9%）低于CD56的特异性（89.4%）。CD56和claudin-1联合使用（claudin-1 + /CD56-）在鉴别FVPC与其他滤泡性结节时显示出特异性（100%）、阳性预测值（100%）和敏感性（81.3%）。根据这一统计结果，10例WDTs-UMP病例中有5例表达（claudin-1 + /CD56-）模式，可重新诊断为PTC。
CD56和claudin-1联合使用有助于诊断FVPC及其与其他滤泡样结节的鉴别。这两种标志物的应用可能极大地有助于对WDTs-UMP进行重新评估并解释其预期行为。
