穿刺细胞学结合免疫组化诊断甲状腺癌  

Fine needle aspiration cytology plus immunohistochemistry staining in the diagnosis of thyroid carcinoma

作　　者：殷志强[1] 张云[1] 徐曙光[1] 朱敬之[1] 唐睿[1] 许雁萍[1] 吴志勇[1] 

机构地区：[1]上海交通大学医学院附属仁济医院普外科,上海200127

出　　处：《外科理论与实践》2009年第2期179-184,共6页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨术前运用细针穿刺甲状腺结节行细胞学检查,结合穿刺细胞液相关免疫组化分析,进一步提高对甲状腺癌的术前诊断的准确率。方法:回顾分析本院2006年10月至2007年3月收治的甲状腺结节43例。术前均穿刺有疑问之甲状腺结节,作细胞学检查,同时结合免疫组化半乳凝集素-3、CK19、TPO进行分析,与手术后石蜡病理结果作比较。①在细胞学检查确诊的良、恶性病例中,细胞免疫组化指标仅作为参考。②而在细胞学诊断为可疑恶性时,免疫组化表达为半乳凝集素-3、CK19均阳性、TPO阴性者,作恶性诊断论;当表达为半乳凝集素-3、CK19均阴性、TPO阳性时,则作良性诊断论;其他种类表达归为可疑诊断。所有病例均接受手术治疗并经病理学检查证实。结果:术前细胞学诊断为乳头状癌者21例,可疑恶性14例,良性病变8例;14例细胞学诊断为可疑恶性的病例,结合免疫组化,10例诊断为乳头状癌,1例髓样癌,3例腺瘤。术后病理确定为乳头状癌31例,滤泡状癌2例,髓样癌1例,腺瘤8例,结节性甲状腺肿1例。43例细胞学诊断与术后病理符合率达62.8%。细胞学结合免疫组化诊断与术后病理符合率达90.7%,敏感性82.4%,特异性100%,阳性预测值100%,阴性预测值均为60%。结论:半乳凝集素-3、TPO和CK19检查有助于判断甲状腺结节的良、恶性;联合检查可提高诊断的准确性。甲状腺细针穿刺细胞学结合穿刺液的免疫组化分析,有助于提高甲状腺癌尤其是乳头状癌的检出率,减少漏诊和误诊。Objectives To evaluate the role of fine needle aspiration cytology plus immunohistochemistry staining in the diagnosis of thyroid malignancy, in order to improve the accuratcy of preoperative diagnosis of thyroid carcinoma. Methods From October 2006 to March 2007, a total of 43 patients with thyroid nodules were admitted; pre-operatively they underwent pre-operative fine needle aspiration for cytologyical examination and galectin-3, CK19 and TPO immunohistochemistry （IHC） staining. The role of IHC staining was as following： （1）in case the cytological finding confirmed malignancy, the IHC results were used as reference, （2） in case the cytological finding indicated suspective, the diagnosis of malignancy was reached basing upon Galectin-3＋, TPO-, CK19＋ in the IHC staining, and the lesion was deemed non-malignant when the IHC staining revealed Galectin-3-, TPO＋, CK19-. The other cases were considered as uncertain. All the patients underwent operation with a definite pathological diagnosis examinations. Results According to the cytological examination, 21 patients were diagnosed as papillary carcinoma, 8 were benign nodular and the other 14 were suspective. Among these 14 cases classified as ＂suspective＂, additional IHC staining demonstrated that 10 cases were papillary carcinomas, one case was medullar carcinoma, and 3 cases were adenoma.The post-operative pathological examination indicated that 31 cases were papillary carcinomas, 2 were follicular carcinomas, 1 was medullar carcinoma, 8 were adenomas and one case was nodular goiter. The rate of concordance between the cytological and pathological examinations was 62.8%. The rate of concordance between the cytology plus IHC staining and the post-operative pathological examination was 90.7%, with the sensitivity of 82.4% and the specificity of 100%. The positive and negative predictive rate was 100% and 60%, respectively. Conclusions The combination of IHC staining of galectin-3,CK19 and TPO to the cytological examination may increase the pos

关 键 词：甲状腺 穿刺细胞学 半乳凝集素-3 TPO CK19 免疫组织化学 

分 类 号：R736.1[医药卫生—肿瘤]