A combined molecular-pathologic score improves risk stratification of thyroid papillary microcarcinoma.
A combined molecular-pathologic score improves risk stratification of thyroid papillary microcarcinoma.
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综合分子病理评分可改善甲状腺乳头状微小癌的风险分层。
DOI：
10.1002/cncr.26425
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发表时间：
2012-04-15
期刊：
影响因子：
6.2
通讯作者：
Nikiforov YE
中科院分区：
文献类型：
--
作者：
Niemeier LA;Kuffner Akatsu H;Song C;Carty SE;Hodak SP;Yip L;Ferris RL;Tseng GC;Seethala RR;Lebeau SO;Stang MT;Coyne C;Johnson JT;Stewart AF;Nikiforov YE
甲状腺乳头状微小癌是一种偶然发现的乳头状癌，大小≤ 1.0 cm。大多数TPMC都是懒惰的，而有些人则表现得咄咄逼人。本研究的目的是评价BRAF突变和特定组织病理学特征的组合是否允许TPMC的风险分层。根据淋巴结转移或肿瘤复发的情况选择一组侵袭性TPMC。一组非侵袭性肿瘤包括年龄、性别和肿瘤大小匹配的TPMC，但没有甲状腺外扩散。进行分子分析，并根据多种组织病理学标准对组织学切片进行评分。对40例TPMC的单独验证队列进行了评价。在77%的侵袭性TPMC和32%的非侵袭性肿瘤中检测到BRAF突变（p=0.001）。几个组织病理学特征显示组间有显著差异。使用多变量回归分析，开发了分子病理学（MP）评分，包括BRAF状态和三个组织病理学特征：浅表肿瘤位置、腺内肿瘤扩散/多灶性和肿瘤纤维化。通过将组织学标准添加到BRAF状态，敏感性从77%增加到96%，特异性从68%增加到80%。在独立验证队列中，MP评分将肿瘤分为低、中和高风险组，淋巴结转移或肿瘤复发的概率分别为0、20%和60%。BRAF状态以及几种组织病理学特征允许对TPMC进行临床风险分层。结合分子病理学危险分层模型是一个更好的预测甲状腺外肿瘤扩散比突变或组织病理学发现单独。
Thyroid papillary microcarcinoma (TPMC) is an incidentally discovered papillary carcinoma that is ≤ 1.0 cm in size. Most TPMCs are indolent, whereas some behave aggressively. The aim of the study was to evaluate whether the combination of BRAF mutation and specific histopathological features allows risk stratification of TPMC. A group of aggressive TPMC was selected based on the presence of lymph node metastasis or tumor recurrence. A group of non-aggressive tumors included TPMCs matched for age, gender, and tumor size, but with no extrathyroidal spread. Molecular analysis was performed and histological slides were scored for multiple histopathological criteria. A separate validation cohort of 40 TPMC was evaluated. BRAF mutation was detected in 77% of aggressive TPMC and 32% of non-aggressive tumors (p=0.001). Several histopathological features showed significant difference between the groups. Using multivariate regression analysis, a molecular-pathological (MP) score was developed that included BRAF status and three histopathological features: superficial tumor location, intraglandular tumor spread/multifocality, and tumor fibrosis. By adding the histologic criteria to BRAF status, sensitivity was increased from 77% to 96% and specificity from 68% to 80%. In the independent validation cohort, the MP score stratified tumors into low, moderate, and high risk groups, with the probability of lymph node metastases or tumor recurrence of 0, 20%, and 60%, respectively. BRAF status together with several histopathological features allow clinical risk stratification of TPMC. The combined molecular-pathological risk stratification model is a better predictor of extrathyroidal tumor spread than either mutational or histopathological findings alone.
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影响因子：
3.3
作者：
KOMOROWSKI, RA;HANSON, GA
通讯作者：
HANSON, GA
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Adeniran, AJ;Zhu, ZW;Nikiforov, YE
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