超声引导下细针穿刺联合FAM172A在甲状腺乳头状癌诊断中的应用价值

Value of Ultrasound-guided Fine Needle Aspiration Combined with FAM172A in the Diagnosis of Papillary Thyroid Carcinoma

目的旨在通过免疫组化和超声引导下细针穿刺(US-FNA),明确FAM172A表达在甲状腺乳头状癌(PTC)中的诊断价值。方法回顾性分析2017年1月~2018年1月在上海交通大学附属第六人民医院术后诊断为甲状腺乳头状癌和腺瘤的患者,纳入50例PTC和20例甲状腺腺瘤(FTA)分别进行FAM172A免疫组化。通过ROC曲线确定FAM172A最佳切点值。前瞻性分析2018年1~6月超声怀疑甲状腺肿瘤患者,纳入20例甲状腺肿瘤患者在超声引导下进行穿刺,取得细胞样本进行FAM172A细胞免疫组化。结果甲状腺乳头状癌与腺瘤患者比较,FAM172A在甲状腺乳头状癌中表达更高(P=0.000)。FAM172A免疫组化评分切点在3.5以上敏感度为92%,特异性为60%。ROC曲线分析结果显示,FAM172A诊断乳头状癌的曲线下面积(AUC)为0.846(P=0.000)。在20个前瞻性病例中,US-FNA结合FAM172A细胞学免疫组化鉴别恶性甲状腺乳头状癌的敏感度和特异性分别为80%和100%。结论FAM172A可能成为一个新型蛋白分子标志物,有助于甲状腺乳头状癌的诊断。

Objective To investigate the diagnostic value of FAM172A expression in papillary thyroid carcinoma(PTC)by immunohistochemistry and ultrasound-guided fine needle aspiration(US-FNA).Methods A retrospective analysis of patients with thyroid papillary carcinoma and adenoma diagnosed in the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from January 2017 to January 2018 was conducted.50 PTC and 20 FA were enrolled in the FAM172A immunohistochemistry.The best cut point value of the FAM172A was determined by the ROC curve.Prospective analysis of patients with suspected thyroid tumors from January 2018 to June 2018,20 patients with thyroid tumors underwent ultrasound-guided puncture,and obtained cell samples for immunohistochemistry of FAM172A cells.Results Compared with adenoma patients,FAM172A was more highly expressed in thyroid papillary carcinoma(P=0.000).Based on the FAM172A immunohistochemical score,the sensitivity was 92%and the specificity was 60%.The ROC curve analysis showed that the area under the curve(AUC)for the diagnosis of papillary carcinoma by FAM172A was 0.846(P=0.000).In 20 prospective cases,the sensitivity and specificity of US-FNA combined with FAM172A cytology immunohistochemistry for identifying malignant thyroid papillary carcinoma were 80%and 100%,respectively.Conclusion FAM172A may be a novel protein molecular marker that contributes to the diagnosis of papillary thyroid carcinoma.