Application of an immunodiagnostic method for improving preoperative diagnosis of nodular thyroid lesions
Application of an immunodiagnostic method for improving preoperative diagnosis of nodular thyroid lesions
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DOI：
10.1016/s0140-6736(00)04817-0
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发表时间：
2001-05-26
期刊：
影响因子：
168.9
通讯作者：
Larsson, O
中科院分区：
文献类型：
--
作者：
Bartolazzi, A;Gasbarri, A;Larsson, O
背景甲状腺癌是最常见的内分泌恶性疾病，但术前诊断仍是一个挑战。细针穿刺细胞学检查已大大改善了甲状腺结节的临床处理，但滤泡病变的术前定性是非常困难的。因此，许多患者因诊断而不是治疗需要而接受手术。我们进行了一项国际多中心的研究，以评估两个潜在的标记物的恶性thyroidcytes.Methods半乳糖凝集素-3和CD 44 v6的表达的免疫组织化学染色的有用性进行了测试1009甲状腺病变（组织标本和细胞学细胞块）和226新鲜的细胞学样本术前超声引导下细针穿刺甲状腺结节（前瞻性分析）。该测试使用特异性单克隆抗体CD 44 v6和半乳糖凝集素-3，间接抗生物素蛋白-生物素复合物免疫过氧化物酶法，和3-氨基-9-乙基咔唑作为substrate.Findings的敏感性，特异性，阳性预测值，和诊断准确性，该测试方法（共表达的两个标志物）在前瞻性分析分别为88%，98%，91%和97%。galectin-3免疫检测对甲状腺良恶性病变的敏感性和特异性分别大于99%和98%，阳性预测值和诊断准确率分别为92%和99%。解释半乳凝素的整合-3免疫组化结合常规细胞形态学和临床诊断程序是一种敏感可靠的术前鉴别诊断方法甲状腺癌这种检测方法提高了常规细胞学诊断的准确性，并为尚未分类的恶性行为不确定的甲状腺肿瘤的新疾病分类提供了分子基础。
Background Thyroid cancer is the most common endocrine malignant disease, but preoperative diagnosis remains a challenge. Fine-needle aspiration cytology has greatly improved the clinical management of thyroid nodules, but the preoperative characterisation of follicular lesions is very difficult. Many patients are thus referred to surgery more for diagnosis than for therapeutic necessity. We undertook an international multicentre study to assess the usefulness of immunohistocytochemical staining for two potential markers of malignant thyrocytes.Methods Expression of galectin-3 and CD44v6 was tested on 1009 thyroid lesions (tissue specimens and cytological cell-blocks) and 226 fresh cytological samples obtained preoperatively by ultrasound-guided fine-needle aspiration of thyroid nodules (prospective analysis). The test used monoclonal antibodies specific for CD44v6 and galectin-3, the indirect avidin-biotin complex immunoperoxidase method, and 3-amino-9-ethylcarbazole as substrate.Findings The sensitivity, specificity, positive predictive value, and diagnostic accuracy of this test method (for coexpression of the two markers) in the prospective analysis were 88%, 98%, 91%, and 97%, respectively. The sensitivity and specificity of galectin-3 immunodetection alone in discriminating benign from malignant thyroid lesions were more than 99% and 98% respectively, and the positive predictive value and diagnostic accuracy were 92% and 99%.Interpretation The integration of galectin-3 immunostaining with conventional cytomorphological and clinical diagnostic procedures represents a sensitive and reliable diagnostic approach for preoperative identification of thyroid carcinomas. This test method improves the diagnostic accuracy of conventional cytology and provides the molecular basis for a new nosological assignation of the not yet classified thyroid neoplasms of indeterminate malignant behaviour.