Chung Soo Young, Lee Jae Seok, Lee Hyebin, Park Sung Hee, Kim Soo Jin, Ryu Han Suk
Department of Pathology, Cancer Center, Dongnam Institute of Radiological and Medical Sciences, Busan, South Korea.
Acta Cytol. 2013;57(3):252-8. doi: 10.1159/000343617. Epub 2013 Apr 25.
Preoperative fine needle aspiration biopsy (FNAB) has become the initial diagnostic method for papillary thyroid carcinoma (PTC). Identification of cytomorphologic factors predicting lymph node metastasis (LNM) is clinically important for determining the appropriate treatment regimen due to the high rate of lymph node involvement in PTC at the time of diagnosis. Hobnail features (HF) have previously been described as potential histomorphologic features in the histological examination of PTC. This study evaluated the value of HF as a predictor of LNM.
Histologically confirmed FNABs (n = 111) of papillary thyroid microcarcinoma prepared by the liquid-based method were enrolled. Along with other cytomorphologic parameters, HF were evaluated for their value in predicting LNM.
Although HF were closely correlated with cytoplasmic vacuoles of tumor cells and background macrophages (p < 0.05), which were considered diagnostic indicators of PTC with cystic changes, HF were only found to be significantly correlated with LNM (p = 0.008). The BRAF(V660E) mutation was not associated with LNM. All combinations including HF were revealed as stronger predictors of LNM (odds ratios: 2.254-2.524, p < 0.05).
HF, a distinctive cytomorphologic feature, may be used as a factor predicting LNM in preoperative FNAB of PTC.
术前细针穿刺活检（FNAB）已成为甲状腺乳头状癌（PTC）的初始诊断方法。由于PTC在诊断时淋巴结受累率高，识别预测淋巴结转移（LNM）的细胞形态学因素对于确定合适的治疗方案具有重要临床意义。鞋钉样特征（HF）此前已被描述为PTC组织学检查中的潜在组织形态学特征。本研究评估了HF作为LNM预测指标的价值。
纳入通过液基方法制备的111例经组织学证实的甲状腺微小乳头状癌的FNAB。除其他细胞形态学参数外，还评估了HF在预测LNM方面的价值。
尽管HF与肿瘤细胞的胞质空泡和背景巨噬细胞密切相关（p < 0.05），而这些被认为是伴有囊性改变的PTC的诊断指标，但仅发现HF与LNM显著相关（p = 0.008）。BRAF（V660E）突变与LNM无关。所有包含HF的组合均显示为更强的LNM预测指标（优势比：2.254 - 2.524，p < 0.05）。
HF作为一种独特的细胞形态学特征，可作为PTC术前FNAB中预测LNM的一个因素。
