免疫组化技术在甲状腺液基细胞学诊断为Ⅲ类-意义不明确细胞非典型病变中的应用价值

The application value of immunohistochemistry in the diagnosis of thyroid fluid based cytology as classⅢatypical lesions with unclear significance

目的:探讨利用免疫组化技术在甲状腺液基细胞学诊断为Ⅲ类-意义不明确细胞非典型病变中的应用价值。方法:选取96例甲状腺细针穿刺液基细胞学诊断为Ⅲ类-意义不明确细胞非典型病变病例,所选病例均通过手术获得术后组织病理诊断结果,细胞涂片完成后利用剩余液基保存液制作细胞块,将术后组织病理与细胞块同时进行CK19、Galectin-3、HBME-1、TPO四种抗体免疫组织化学检测。依据组织病理结果将选取病例分为甲状腺乳头状癌组和良性组,分析两组中四种抗体在细胞块免疫组化染色中的表达情况,并进行对比分析,以验证在免疫组化中细胞块与组织病理表达的一致性。结果:选取的96例甲状腺细针穿刺液基细胞学Ⅲ类病例,其中18例因剩余细胞量少蜡块制作不成功,78例细胞块制作成功的病例依据组织学诊断分为甲状腺癌组及良性组。甲状腺癌组中CK19、Galectin-3、HBME-1表达率明显高于良性组(P均=0.000),而TPO在良性组中的表达率明显高于甲状腺癌组(P=0.000),差异均具有统计学意义(P<0.05),四种免疫组化标记物诊断甲状腺癌均具有较高的敏感性、准确性和特异性。甲状腺癌组中免疫组化结果对比分析CK19、Galectin-3、HBME-1、TPO在细胞块与组织病理中的表达一致,无统计学差异(P> 0.05)。结论:细胞块免疫组化在甲状腺细针穿刺液基细胞学诊断为Ⅲ类-意义不明确细胞非典型病变中应用价值较大,其结果与术后组织病理符合率高,能提高细胞学诊断的准确率。

Objective:To investigate the application value of immunohistochemistry in the diagnosis of thyroid fluid based cytology as classⅢatypical lesions with unclear significance.Methods:96 cases of thyroid fine needle aspiration liquid-based cytology were selected for diagnosis of classⅢatypical cell lesions with unclear significance.All the selected cases were diagnosed by operation.After the cell smear was completed,the cell block was made with the remaining liquid based preservation solution.The postoperative pathological specimen and cell block were sectioned and immunohistochemical detection of CK19,Galectin-3,HBME-1 and TPO were carried out.According to the histopathological results,the selected cases were divided into thyroid papillary group and benign group.The expression of four kinds of antibodies in two groups in cell block immunohistochemical staining and comparative analysis.The consistency of cell block and histopathology in immunohistochemistry was verified.Results:In 96 cases of thyroid fine needle aspiration with liquid based cytology.18 cases failed to make wax block due to the small amount of remaining cells,and 78 cases were divided into thyroid cancer group and benign group according to histological diagnosis.The expression rate of CK19,Galectin-3 and HBME-1 in thyroid cancer group was significantly higher than that in benign group(all P=0.000).The expression rate of TPO in benign group was significantly higher than that in thyroid cancer group(P=0.000).The difference was statistically significant(P<0.05).The four immunohistochemical markers have high sensitivity,accuracy and specificity in the diagnosis of thyroid cancer.The expression of CK19,Galectin-3,HBME-1 and TPO in thyroid cancer cell block was the same as that in postoperative histopathology with no statistical difference(P>0.05).Conclusion:The application value of cell block immunohistochemistry in the diagnosis of thyroid fine needle aspiration fluid based cytology as classⅢ-atypical lesions with unclear significance is larger.The coincidence rate between the results and the postoperative histopathology is high.It can improve the accuracy of cytological diagnosis.