细针抽吸物中中期因子比值对细胞学不确定甲状腺结节评估的诊断性能。
Diagnostic performance of Midkine ratios in fine-needle aspirates for evaluation of Cytologically indeterminate thyroid nodules.
机构信息
Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, The China-Japan Union Hospital of Jilin University, 126 Xiantai Street, Changchun City, 130033, Jilin Province, China.
Division Of Laboratory Medicine Center, The China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
出版信息
Diagn Pathol. 2021 Oct 25;16(1):92. doi: 10.1186/s13000-021-01150-y.
BACKGROUND
Fine-needle aspiration cytology (FNAC) is a basic diagnostic tool for thyroid nodules. However, 15-30% of nodules are cytologically indeterminate. Midkine (MK), a pleiotropic growth factor, is often upregulated in patients with cancers. This study aimed to evaluate the role of MK and its ratios in fine-needle aspirates (FNA) for predicting thyroid malignancy.
METHODS
This retrospective study included patients with thyroid nodules who underwent preoperative FNA and/or thyroidectomy between April 2017 and September 2017. MK levels in FNA washout were measured by enzyme-linked immunosorbent assay, and thyroglobulin (TG) and free thyroxine (FT4) levels in FNA washout were measured by chemiluminescent immunometric assays.
RESULTS
A total of 217 patients with 242 nodules were included in this study. The concentrations of TG, FT4, MK/TG, MK/FT4, and FT4/MK were significantly different between papillary thyroid carcinomas and benign thyroid nodules. Both MK/TG and MK/FT4 ratios were positively correlated with maximum tumor diameter, extrathyroidal extension, and T and N stages. The area under the curve for MK/TG was 0.719 with a cutoff value of 55.57 ng/mg, while the area under the curve for MK/FT4 was 0.677 with a cutoff value of 0.11 μg/pmol. FNAC in combination with MK/FT4 had a higher sensitivity (95% vs. 91%) and accuracy (96% vs. 92%) than FNAC alone for cytologically indeterminate specimens, those of unknown significance, or those suspected of malignancy.
CONCLUSIONS
MK/FT4 and MK/TG may have diagnostic utility for evaluation of papillary thyroid carcinomas, particularly for cytologically indeterminate thyroid nodules.
背景
细针穿刺细胞学检查（FNAC）是甲状腺结节的基本诊断工具。然而，15-30%的结节细胞学检查结果不确定。中期因子（MK）是一种多效生长因子，在癌症患者中常上调。本研究旨在评估 MK 及其比值在细针抽吸物（FNA）中预测甲状腺恶性肿瘤的作用。
方法
本回顾性研究纳入了 2017 年 4 月至 2017 年 9 月期间接受术前 FNA 和/或甲状腺切除术的甲状腺结节患者。通过酶联免疫吸附试验测量 FNA 洗脱液中的 MK 水平，并通过化学发光免疫测定法测量 FNA 洗脱液中的甲状腺球蛋白（TG）和游离甲状腺素（FT4）水平。
结果
本研究共纳入 217 例 242 个结节患者。乳头状甲状腺癌与良性甲状腺结节之间的 TG、FT4、MK/TG、MK/FT4 和 FT4/MK 浓度差异有统计学意义。MK/TG 和 MK/FT4 比值均与最大肿瘤直径、甲状腺外侵犯、T 和 N 分期呈正相关。MK/TG 的曲线下面积为 0.719，截断值为 55.57ng/mg，而 MK/FT4 的曲线下面积为 0.677，截断值为 0.11μg/pmol。FNAC 联合 MK/FT4 对细胞学不确定、意义不明或疑似恶性的标本的敏感性（95%比 91%）和准确性（96%比 92%）均高于单独 FNAC。
结论
MK/FT4 和 MK/TG 可能对评估甲状腺乳头状癌具有诊断价值，特别是对细胞学不确定的甲状腺结节。
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