Development of new indicator in biological malignancy of thyroid carcinoma preoperatively using aspiration biopsy cytology (ABC)

为了在术前确定甲状腺癌的生物恶性程度，我们首先尝试了免疫染色的细胞学标本收集的吸活检。然而，由于技术困难，这一计划失败了。因此，我们决定尝试通过组织标本的免疫组织化学检查来确定甲状腺癌的恶性程度。观察了C-myc p62、C-Ha-ras p21、表皮生长因子（EGF）、转化生长因子（TGFalpha）、雌激素受体（ER）作为恶性肿瘤指标的表达。C-myc p62的免疫活性在预后不良的未分化癌中高频率表达（91.7%）。乳头状癌淋巴结转移患者免疫活性阳性的比例特别高（P<0.01）。阳性细胞数量较多的肿瘤，预后指标EOPTC值较低，阳性比值与预后呈负相关。c-Ha-ras p21、EGF或TGFalpha阳性患者的比例与甲状腺癌的组织学类型或临床恶性程度没有明确的相关性。通过检查这些指标的表达来鉴别诊断滤泡腺瘤和滤泡癌是不可能的。技术上的困难。因此，我们决定通过检查来尝试滤泡癌是不可能的。基于这些发现，可以说C-myc p62和ER的表达作为甲状腺癌恶性程度的指标是有价值的。值得注意的是，术前通过比较术前抽吸细胞学标本中癌胚抗原和降钙素的表达，可以完美地鉴别髓质癌和未分化癌，即我们的最初目的已经成功实现。

With the aim of preoperative determination of the biological malignancy of thyroid carcinoma, we first attempted immunological staining of cytologic specimens collected by aspiration biopsy. However this failed due to technical difficulties. Thus, we decided to attempt to determine the malignancy of thyroid carinoma by immunohistochemical examination of histologic specimens. Expression of C-myc p62, C-Ha-ras p21, epidermal growth factor (EGF), transforming growth factor (TGFalpha), and estrogen reception (ER), as indicators of malignancy, was observed/ The findings are summarized as follows:1. Immunological activity of C-myc p62 was expressed at a high frequency (91.7%) in undifferentiated carinomas having a poor prognosis. A particularly high ratio of patients with papillary carcinoma lymphnode metastasis were positive for the immunological activity (P<0.01).2. In carcinomas involving a larger number of Erpositive cells, lower values of EOPTC (an index of prognosis) were obtained, with a negative correlation of the ERpositivity ratio with prognosis.3. There was no definite correlation of the ratio of patients positive for c-Ha-ras p21, EGF or TGFalpha, with the histologic type or clinical malignacy of thyroid carinoma.4. Differential diagnosis of follicular adenoma and follicular carcinoma was impossible by an examination of the expression of these various indicators. to technical difficulties. Thus, we decided to attempt follicular carcinoma was impossible by an examination of Bases on these findings, it can be said that C-myc p62 abd ER in their expression are valuable as indicators of malignancy of thyroid carcinoma.It should also be noted that perfect preoperative differential diagnosis of medullary carcinoma and undifferentiated carcinoma was possible by comparing the expression of carcinoembrionic antigen and that of carcitonin on cytologic specimens collected by aspiration before surgery, i.e., our initial aim was successfully accomplished.