高频超声引导下甲状腺粗针穿刺联合CD56、Galectin-3、HBME-1、CK-19检测PTMC的诊断价值  

Diagnostic Value of High Frequency Ultrasound Guided Thyroid Coarse Needle Puncture Combined with CD56,Galectin-3,HBME-1 and CK-19 in PTMC

作　　者：李映东 李文仿[1] 章书铭 赵宗彬[1] 王耕[1] LI Yingdong;LI Wenfang;ZHANG Shuming;ZHAO Zongbin;WANG Geng(Breast and Thyroid Center,Taihe Hospital Affiliated to Hubei University of Medicine,Shiyan 442000,Hubei,China)

机构地区：[1]湖北医药学院附属太和医院乳腺甲状腺中心,湖北十堰442000

出　　处：《医学信息》2024年第23期19-23,共5页Journal of Medical Information

基　　金：湖北省陈孝平科技发展基金菁锐发展基金(编号:CXPJJH122006-1018);十堰市科技局指导项目(编号:22Y32)。

摘　　要：目的探索甲状腺微小乳头状癌(PTMC)粗针穿刺诊断,以及联合CD56、Galectin-3、HBME-1、CK-19免疫组化检测,对甲状腺微小乳头状癌的鉴别诊断价值。方法根据甲状腺彩超TI-RADS分级结果,结合超声影像学表现,对0.3 cm<甲状腺结节直径≤1.0 cm甲状腺Ⅵ类结节粗针穿刺。结合术中冰冻、术后病检结果,联合CD56、Galectin-3、HBME-1、CK-19检测,分析甲状腺粗针穿刺结合免疫组化对甲状腺微小乳头状癌鉴别诊断价值。结果甲状腺结节TI-RADS分级Ⅵ级,且0.3 cm<结节直径≤1 cm共120例。CNB确定诊断甲状腺癌73例,42例诊断良性甲状腺组织,免疫组化行协助诊断33例。诊断准确性为89.17%,灵敏度为84.88%,特异度为100.00%,阳性预测值为100.00%,阴性预测值为72.34%。免疫组化行协助诊断33例,CD56蛋白在PTMC患者中的阳性率为6.00%,且染色强度呈弱阳性表达模式,PTMC患者中Galectin-3、CK-19和HBME-1蛋白阳性率分别为100.00%、100.00%和87.88%。PTMC患者中CK-19/Galectin-3、Galectin-3/HBME-1和CK-19/HBME-1双组合的阳性率分别为100.00%、87.88%和87.88%。所有患者无严重出血、气胸、气管或神经损伤等并发症。结论甲状腺粗针穿刺对甲状腺微小乳头状癌可提供重要参考信息。PTMC患者中CK-19/Galectin-3双组合阳性在粗针穿刺甲状腺组织提供更高鉴别诊断依据。Objective To explore the value of coarse needle biopsy combined with immunohistochemical detection of CD56,Galectin-3,HBME-1 and CK-19 in the differential diagnosis of papillary thyroid microcarcinoma(PTMC).Methods According to the results of TI-RADS classification of thyroid color Doppler ultrasound,combined with ultrasound imaging findings,coarse needle puncture was performed on thyroidⅥnodules with a diameter of 0.3 cm<thyroid nodules≤1.0 cm.Combined with the results of intraoperative freezing and postoperative pathological examination,and the detection of CD56,Galectin-3,HBME-1 and CK-19,the value of thyroid coarse needle puncture combined with immunohistochemistry in the differential diagnosis of papillary thyroid microcarcinoma was analyzed.Results There were 120 cases of thyroid nodules TI-RADS gradeⅥand 0.3 cm<nodule diameter≤1 cm.CNB confirmed 73 cases of thyroid cancer,42 cases of benign thyroid tissue,and 33 cases were confirmed by immunohistochemistry.The diagnostic accuracy was 89.17%,the sensitivity was 84.88%,the specificity was 100.00%,the positive predictive value was 100.00%,and the negative predictive value was 72.34%.33 cases were confirmed by immunohistochemistry,the positive rate of CD56 protein in patients with PTMC were 6.00%,and the staining intensity was weakly positive.The positive rates of Galectin-3,CK-19 and HBME-1 protein in patients with PTMC were 100.00%,100.00%and 87.88%,respectively.The positive rates of CK-19/Galectin-3,Galectin-3/HBME-1 and CK-19/HBME-1 in PTMC group were 100.00%,87.88%and 87.88%,respectively.All patients had no serious bleeding,pneumothorax,trachea or nerve injury and other complications.Conclusion Thyroid coarse needle puncture can provide important reference information for papillary thyroid microcarcinoma.CK-19/Galectin-3 double combination positive in patients with PTMC have a higher basis for differential diagnosis in coarse needle aspiration thyroid tissue.

关 键 词：粗针穿刺 甲状腺微小乳头状癌 免疫组化 诊断价值 

分 类 号：R737.9[医药卫生—肿瘤]