联合检测Galectin-3、BRAF V600E、TPO和CD56在甲状腺良恶性结节中的应用价值

Practical value of combined detection of Galectin-3,BRAF V600E,TPO and CD56 in benign and malignant thyroid nodules

目的检测半乳糖凝集素-3(Galectin-3)、BRAF V600E、甲状腺过氧化物酶(TPO)和神经细胞黏附分子(CD56)在甲状腺结节中的表达水平,探讨4种标志物在病理诊断和鉴别诊断甲状腺良、恶性结节中的应用价值。方法448例甲状腺术后患者的病理标本,其中186例患者的病理标本为良性结节,设为良性组;262例患者的病理标本为甲状腺乳头状癌,设为恶性组。采用免疫组织化学法染色,标记Galectin-3、BRAF V600E、TPO和CD56在两组病变中的表达。对比两组Galectin-3、BRAF V600E、TPO和CD56阳性表达率;Galectin-3、BRAF V600E、TPO和CD564种蛋白单一检测和联合检测效能。结果恶性组Galectin-3、BRAF V600E阳性表达率分别为93.51%、81.68%,明显高于良性组的8.60%、1.08%;TPO、CD56阳性表达率分别为14.89%、7.63%,明显低于良性组的100.00%、98.92%,差异具有统计学意义(P<0.05)。恶性组Galectin-3和BRAF V600E同时阳性率为75.57%,明显高于良性组的1.08%,差异具有统计学意义(P<0.05)。恶性组TPO和CD56同时阳性率为6.49%,明显低于良性组的91.40%,差异具有统计学意义(P<0.05)。Galectin-3、BRAF V600E、TPO和CD56联合诊断的灵敏度、特异度及准确度均高于各项指标单一诊断。结论Galectin-3、BRAF V600E、TPO和CD56是甲状腺良、恶性病变鉴别诊断的重要辅助指标,Galectin-3和BRAF V600E阳性表达、TPO和CD56阴性表达是诊断甲状腺乳头状癌的特异性标志物,形态学诊断联合检测4种标志物有助于提高甲状腺乳头状癌的诊断准确性。

Objective To detect the expression levels of Galectin-3,BRAF V600E,thyroid peroxidase(TPO),and neural cell adhesion molecule(CD56)in thyroid nodules,and discuss the practical value of four markers in pathological diagnosis and differential diagnosis of benign and malignant thyroid nodules.Methods A total of 448 cases of thyroid postoperative pathological specimens were selected,of which 186 pathological specimens were benign nodules and were set as the benign group,and 262 pathological specimens were papillary thyroid carcinoma and were set as the malignant group.Immunohistochemical staining was used to mark the expression of Galectin-3,BRAF V600E,TPO and CD56 in the two groups of lesions.The positive expression rates of Galectin-3,BRAF V600E,TPO and CD56 were compared between the two groups;the single detection and combined detection efficiency of Galectin-3,BRAF V600E,TPO and CD56 were compared.Results The positive expression rate of Galectin-3 and BRAF V600E in the malignant group were 93.51%and 81.68%,respectively,which were significantly higher than 8.60%and 1.08%in the benign group;the positive expression rates of TPO and CD56 in the malignant group were 14.89%and 7.63%,respectively,which were significantly lower than 100.00%and 98.92%in the benign group.All the difference was statistically significant(P<0.05).The simultaneous positive rate of Galectin-3 and BRAF V600E in the malignant group was 75.57%,which was significantly higher than 1.08%in the benign group,and the difference was statistically significant(P<0.05).The simultaneous positive rate of TPO and CD56 in the malignant group was 6.49%,which was significantly lower than 91.40%in the benign group,and the difference was statistically significant(P<0.05).The sensitivity,specificity and accuracy of the combined diagnosis of Galectin-3,BRAF V600E,TPO and CD56 were all higher than those of single diagnosis.Conclusion Galectin-3,BRAF V600E,TPO and CD56 are important auxiliary indicators in the differential diagnosis of benign and malignant thyroid lesions.The positive expression of Galectin-3 and BRAF V600E,and the negative expression of TPO and CD56 are specific markers for the diagnosis of papillary thyroid carcinoma.The combined detection of 4 markers in morphological diagnosis helps to improve the diagnostic accuracy of papillary thyroid carcinoma.