ACR TI-RADS超声评分联合CK19、galectin-3和HBME-1对甲状腺微小乳头状癌的诊断价值

Diagnostic value of ACR TI-RADS ultrasound-score combined with CK19,galectin-3,and HBME-1 in papil⁃lary thyroid micro-carcinoma

目的探讨美国放射学会甲状腺影像报告和数据系统(ACR TI-RADS)超声评分联合免疫组化染色标记物细胞角蛋白19(CK19)、半乳糖凝集素3(galectin-3)及人骨髓内皮细胞标记物(HBME-1)对甲状腺微小乳头状癌(PTMC)的诊断价值。方法选择PTMC患者130例为实验组,选择结节性甲状腺肿、甲状腺腺瘤患者130例为对照组。术前根据甲状腺超声影像的ACR TI-RADS评分标准进行分级。术后蜡块应用Evision二步法行CK19、galectin-3及HBME-1指标的免疫组化检测。以病理结果作为最终确定PTMC的金标准,采用受试者工作特征曲线(ROC)分析四项指标对PTMC的诊断价值。结果实验组ACR TI-RADS分级为4级64例、5级66例。对照组工ACR T1-RADS分级1级6例、2级15例、3级66例、4级43例。两组比较差异有统计学意义(U=1376.00,P<0.05)。实验组癌细胞中CK19、galectin-3、HBME-1的阳性表达率明显高于对照组上皮细胞(χ^2分别=142.55、170.57、82.22,P均<0.05)。ACR TI-RADS超声评分联合CK19、galectin-3及HBME-1免疫组化染色的曲线下面积(0.99)高于ACR TI-RADS超声评分(0.92)、CK19(0.86)、galectin-3(0.90)及HBME-1(0.78),差异均有统计学意义(χ^2分别=80.30、147.42、102.20、243.98,P均<0.05)。结论ACR TI-RADS超声评分联合免疫标记物CK19、galectin-3及HBME-1可以提高PTMC的诊断效能。

Objective To investigate the diagnostic value of American college of radiology throid imaging reporting and data system(ACR TI-RADS)ultrasound-score combined with the immunohistochemical markerscytokeratin19(CK19),galectin-3 and hector battifora mesothelial epitope-1(HBME-1)in the papillary thyroid micro-carcinoma(PTMC).Methods Totally 130 cases of PTMC were selected as experimental group,and 130 cases of nodular goiter and thyroid adenoma were selected as control group.All patients were scored according to ACR TI-RADS score of thyroid ultrasound images before operation.The CK19,galectin-3,and HBME-1 were detected by immunohistochemistry.Pathological results were used as the gold standard for the final diagnosis of papillary thyroid carcinoma.The diagnostic values of these parameters in PTMC were analyzed by ROC.Results In the experimental group,64 cases were grade 4 and 66 cases were grade 5.In the control group,there were 6 cases of grade 1,15 cases of grade 2,66 cases of grade 3,43 cases of grade 4,respectively.There was statistically significant difference(U=1376.00,P<0.05).The positive expressions of CK19,galectin-3,and HBME-1 in cancer cells of the experimental group were significantly higher than those of epithelial cells of the control group(χ^2=142.55,170.57,82.22,P<0.05).The area under the receiver operating characteristic(ROC)curve of the ACR TI-RADS combined with CK19,galectin-3,and HBME-1 immunohistochemical staining was 0.99,which was higher than the that of ACR TI-RADS ultrasound score,CK19,galectin-3,and HBME-1,respectively(χ^2=80.30,147.42,102.20,243.98,P<0.05).Conclusion ACR TI-RADS ultrasound score combined with immune markers CK19,galectin-3 and HBME-1 can improve the diagnostic efficiency of PTMC.