Cha Hyunseo, Pyo Ju Yeon, Hong Soon Won
Department of Pathology, Gangnam Severance Hospital, Seoul, Korea.
J Pathol Transl Med. 2018 Nov;52(6):404-410. doi: 10.4132/jptm.2018.09.20. Epub 2018 Oct 15.
Fine-needle aspiration cytology serves as a safe, economical tool in evaluating thyroid nodules. However, about 30% of the samples are categorized as indeterminate. Hence, many immunocytochemistry markers have been studied, but there has not been a single outstanding marker. We studied the efficacy of CD56 with human bone marrow endothelial cell marker-1 (HBME-1) in diagnosis in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) category III.
We reviewed ThinPrep liquid-based cytology (LBC) samples with Papanicolaou stain from July 1 to December 31, 2016 (2,195 cases) and selected TBSRTC category III cases (n = 363). Twenty-six cases were histologically confirmed as benign (six cases, 23%) or malignant (20 cases, 77%); we stained 26 LBC slides with HBME-1 and CD56 through the cell transfer method. For evaluation of reactivity of immunocytochemistry, we chose atypical follicular cell clusters.
CD56 was not reactive in 18 of 20 cases (90%) of malignant nodules and showed cytoplasmic positivity in five of six cases (83%) of benign nodules. CD56 showed high sensitivity (90.0%) and relatively low specificity (83.3%) in detecting malignancy (p = .004). HBME-1 was reactive in 17 of 20 cases (85%) of malignant nodules and was not reactive in five of six cases (83%) of benign nodules. HBME-1 showed slightly lower sensitivity (85.0%) than CD56. The specificity in detecting malignancy by HBME-1 was similar to that of CD56 (83.3%, p = .008). CD56 and HBME-1 tests combined showed lower sensitivity (75.0% vs 90%) and higher specificity (93.8% vs 83.3%) in detecting malignancy compared to using CD56 alone.
Using CD56 alone showed relatively low specificity despite high sensitivity for detecting malignancy. Combining CD56 with HBME-1 could increase the specificity. Thus, we suggest that CD56 could be a useful preoperative marker for differential diagnosis of TBSRTC category III samples.
细针穿刺细胞学检查是评估甲状腺结节的一种安全、经济的工具。然而，约30%的样本被归类为不确定。因此，人们研究了许多免疫细胞化学标志物，但尚未有一个突出的标志物。我们研究了CD56与人类骨髓内皮细胞标志物-1（HBME-1）在甲状腺细胞病理学报告贝塞斯达系统（TBSRTC）III类诊断中的有效性。
我们回顾了2016年7月1日至12月31日采用巴氏染色的ThinPrep液基细胞学（LBC）样本（2195例），并选择了TBSRTC III类病例（n = 363）。26例经组织学证实为良性（6例，23%）或恶性（20例，77%）；我们通过细胞转移法用HBME-1和CD56对26张LBC玻片进行染色。为了评估免疫细胞化学的反应性，我们选择了非典型滤泡细胞簇。
20例恶性结节中有18例（90%）CD56无反应，6例良性结节中有5例（83%）CD56显示胞质阳性。CD56在检测恶性肿瘤时显示出高敏感性（90.0%）和相对较低的特异性（83.3%）（p = 0.004）。20例恶性结节中有17例（85%）HBME-1有反应，6例良性结节中有5例（83%）HBME-1无反应。HBME-1的敏感性略低于CD56（85.0%）。HBME-1检测恶性肿瘤的特异性与CD56相似（83.3%，p = 0.008）。与单独使用CD56相比，联合CD56和HBME-1检测在检测恶性肿瘤时显示出较低的敏感性（75.0%对90%）和较高的特异性（93.8%对83.3%）。
单独使用CD56在检测恶性肿瘤时尽管敏感性高，但特异性相对较低。将CD56与HBME-1联合使用可提高特异性。因此，我们建议CD56可能是TBSRTC III类样本术前鉴别诊断的有用标志物。
