Ao Yongqiang, Deng Jie, Jiang Jiahao, Yao Min, Gao Jian, Wang Shuai, Jin Chun, Liu Qiuyue, Zhai Yunze, Du Fengxue, Zhang Yu, Zhang Juan, Zheng Yuejuan, Ren Jiazi, Yu Zuoren, Shen Yunli, Ke Aiwu, Cao Yongbing, Wang Haikun, Ding Jianyong
Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Med Surg (Lond). 2025 Feb 11;87(2):515-526. doi: 10.1097/MS9.0000000000002921. eCollection 2025 Feb.
Traditional histological methods for identifying ectopic thymus (ET) have significant limitations including high risk of false negatives. This study aims to evaluate the effectiveness of flow cytometry in detecting ETs in patients undergoing total thymectomy.
We analyzed 864 samples from 103 patients using flow cytometry and hematoxylin and eosin (H&E) staining. ETs were identified by the presence of CD3TCRvβCD4CD8 T cells in flow cytometry or Hassall's corpuscles in H&E staining.
In the discovery set, flow cytometry detected ETs in 69.2% of samples, compared to 23.6% by histological methods. The validation set showed a higher incidence of ETs in myasthenia gravis (MG) patients than in non-MG patients (73.5% vs. 58.0%, < 0.0001) and in those with thymic epithelial tumors versus normal thymus (68.1% vs. 58.1%, = 0.0088). MG patients exhibited a higher prevalence of active ETs, characterized by a high proportion of CD4CD8 T cells, indicating robust thymopoiesis, compared to those without MG ( = 0.0001). Specific regions, such as the left cervical root, areas along the right and left phrenic nerves, and the left innominate vein, showed significantly higher activity ( < 0.05). Additionally, ETs were more frequently found in the cervical region than in the mediastinum (75.0% vs. 60.8%, = 0.0012), and in patients aged 40 years or younger compared to those older than 40 years (73.0% vs. 60.6%, = 0.0027).
Flow cytometry is a viable alternative for ET detection, providing a novel distribution map that enhances surgical decision-making in MG treatment.
传统的组织学方法用于识别异位胸腺（ET）存在显著局限性，包括假阴性风险高。本研究旨在评估流式细胞术在全胸腺切除术患者中检测ET的有效性。
我们使用流式细胞术和苏木精-伊红（H&E）染色分析了103例患者的864份样本。通过流式细胞术中CD3TCRvβCD4CD8 T细胞的存在或H&E染色中的哈氏小体来识别ET。
在发现集中，流式细胞术在69.2%的样本中检测到ET，而组织学方法为23.6%。验证集显示，重症肌无力（MG）患者中ET的发生率高于非MG患者（73.5%对58.0%，<0.0001），胸腺上皮肿瘤患者中ET的发生率高于正常胸腺患者（68.1%对58.1%，=0.0088）。与无MG的患者相比，MG患者中活跃ET的患病率更高，其特征是CD4CD8 T细胞比例高，表明胸腺生成活跃（=0.0001）。特定区域，如左颈根部、左右膈神经沿线区域和左无名静脉，显示出明显更高的活性（<0.05）。此外，ET在颈部区域比在纵隔中更常见（75.0%对60.8%，=0.0012），在40岁及以下患者中比40岁以上患者更常见（73.0%对60.6%，=0.0027）。
流式细胞术是检测ET的可行替代方法，提供了一种新的分布图，可增强MG治疗中的手术决策。
