Rivera Jonathan P, Hang Jen-Fan
Department of Laboratories, Philippine General Hospital, Manila, Philippines.
Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Shipai Rd, No. 201, Sec. 2, Taipei, 11217, Taiwan.
Endocr Pathol. 2025 Mar 20;36(1):8. doi: 10.1007/s12022-025-09851-6.
An integrative histologic and molecular classification of thyroid tumors has become clinically relevant due to the potential role in risk stratification and selection of targeted therapy. In this review, we discuss the applications of six "next-generation" immunohistochemical markers, namely BRAF V600E (clone VE1), RAS Q61R (clone SP174), pan-TRK (clone EPR 17341), ALK (clones 5A4 or D5F3), PTEN, and β-catenin in the pathologic diagnosis and molecular classification of thyroid tumors. These biomarkers allow the in situ examination of tumor tissue and assist in the diagnosis and pathologic staging by highlighting tumor border and patterns of invasion, identifying isolated tumor cells in lymph nodes, distinguishing lymph node metastasis from benign intranodal thyroid inclusions, and diagnosing multicentric thyroid carcinomas with discordant molecular drivers. Furthermore, it can identify specific thyroid neoplasms that may occur sporadically or may be associated with hereditary syndromes. The next-generation immunohistochemistry provides a novel solution to challenging issues in thyroid pathology and fast turn-around time for accurate molecular classification and further guidance of therapeutic management.
由于甲状腺肿瘤的整合组织学和分子分类在风险分层及靶向治疗选择中具有潜在作用，已在临床上具有相关性。在本综述中，我们讨论六种“新一代”免疫组化标志物，即BRAF V600E（克隆号VE1）、RAS Q61R（克隆号SP174）、泛TRK（克隆号EPR 17341）、ALK（克隆号5A4或D5F3）、PTEN和β-连环蛋白在甲状腺肿瘤病理诊断和分子分类中的应用。这些生物标志物可对肿瘤组织进行原位检查，并通过突出肿瘤边界和浸润模式、识别淋巴结中的孤立肿瘤细胞、区分淋巴结转移与良性结内甲状腺包涵体以及诊断具有不一致分子驱动因素的多中心甲状腺癌，协助诊断和病理分期。此外，它还可以识别可能散发性发生或可能与遗传综合征相关的特定甲状腺肿瘤。新一代免疫组化技术为甲状腺病理学中具有挑战性的问题提供了一种新的解决方案，并能快速给出结果以进行准确的分子分类及进一步指导治疗管理。
