高分子量角蛋白、CK19和TPO在甲状腺乳头状癌和良性病变中的表达及意义

The study on the role of high molecular weight keratin,CK19 and TPO protein in the differentiated diagnosis between thyroid papillary carcinoma and benign thyroid diseases

目的探讨高分子量角蛋白(34βE12)、CK19和TPO蛋白在甲状腺乳头状癌及良性病变中的表达以及在甲状腺乳头状癌诊断中的作用。方法用免疫组化EnVision法检测93例甲状腺乳头状癌、102例甲状腺良性病变(51例为结节性甲状腺肿伴滤泡上皮乳头状增生、51例为甲状腺腺瘤)和50例形态学难确诊的甲状腺滤泡上皮乳头状增生病变标本中34βE12、CK19和TPO表达情况,对50例形态学难确诊的滤泡上皮乳头状增生的病例进行随访。结果93例甲状腺乳头状癌34βE12、CK19和TPO表达的阳性率分别为90.32%、100%和8.6%;51例结甲伴滤泡上皮乳头状增生34βE12、CK19和TPO表达的阳性率分别为0、17.6%和100%,51例甲状腺腺瘤34βE12、CK19和TPO表达的阳性率分别为1.96%、33.33%、88.24%;50例形态学难以确诊的甲状腺乳头状增生病变34βE12、CK19和TPO表达的阳性率分别为12%、56%、98%。34βE12、CK19和TPO在甲状腺乳头状癌诊断中的评价指标的敏感度分别为90.32%、100%和91.40%;特异度分别为99.09%、74.51%和94.12%;准确度分别为94.87%、86.67%和87.69%。平行试验显示,34βE12和TPO联合应用敏感度为99.4%,特异度为93.6%。结论34βE12、CK19和TPO蛋白均可作为甲状腺乳头状癌和良性病变鉴别诊断的重要标志物。

Objective To study the role of high molecular weight keratin （34βE12）, CK19 and TPO protein in the differentiated diagnosis between thyroid papillary carcinoma and benign thyroid diseases. Methods The expression of 34βE12, CK19 and TPO protein in 93 eases of papillary thyroid carcinoma and 102 cases of benign thyroid diseases（51 eases of benign thyroid papillary hyperplasia and 51 cases of thyroid follicular adenomas）＇ as well as 50 cases of suspicious thyroid papillary carcinoma in histopathology were detected by cal EnVision method. Results Of the 93 eases of thyroid papillary carcinoma, the positive rates of 34βE12, CK19 and TPO were 90. 32%, 100% and 8.6%, respectively; while all of the 51 cases of thyroid benign papillary hyperplasia were negative to 34βE12 and positive to TPO, 17.6% of them were positive to CK19;of the 51 cases of thyroid follicular adenomas, the positive rates of 341~E12, CK19 and TPO were 1.96% ,33.33% ,88.24% ; respectively;and of the 50 cases of suspicious thyroid papillary carcinoma in histopathology, the positive rates of 34βE12, CK19 and TPO were 12% ,56% ,98% ,respectively. The assessed values of 34βE12, CK19 and TPO in the diagnosis of thyroid papillary carcinoma were below： the sensitivity were 90. 32%, 100% and 91.4% ,the specifity were 99.09%, 74. 51% and 94. 12% ,the accuracy were 94. 87%, 86. 67% and 87. 69% ,respectively. Parallel test showed that when combined with 34βE12 and TPO, the sensitivity was improved to 99. 4%, and the speeifity was 93.6%. Conclusion 34βE12, CK19 and TPO proteins are useful markers in the differentiated diagnosis between thyroid papillary carcino- ma and benign thyroid diseases.