免疫组织化学在甲状腺结节诊断中的运用

Application of immunohistochemistry in the diagnosis of thyroid nodules

目的探讨免疫组织化学在甲状腺结节诊断中的作用。方法回顾性分析2016年1月至2019年12月于杭州市中医院行甲状腺细针穿刺活检的526例甲状腺结节标本,其中结节性甲状腺肿98例,桥本甲状腺炎30例,甲状腺腺瘤198例,甲状腺乳头状癌(papillary thyroid cancer,PTC)200例。免疫组织化学采用抗体包括MC、cyclin D1、CD56、TTF-1。观察此免疫组织化学组合在甲状腺良性病变与PTC间的表达差异。结果PTC与甲状腺良性病变的TTF-1表达比较差异无统计学意义(P>0.05)。PTC的CD56表达显著低于甲状腺良性病变(P<0.001),PTC的MC、cyclin D1表达均显著高于甲状腺良性病变(P<0.001)。MC、CD56、cyclin D1联合诊断PTC的敏感度84.5%,特异性99.1%,阳性预测值98.5%,阴性预测值90.4%。PTC患者的TTF-1、CD56、MC、cyclin D1表达在不同性别、年龄、肿瘤大小、N分期、M分期比较,差异均无统计学意义(P>0.05)。结论免疫组织化学MC、cyclin D1、CD56、TTF-1组合是术前鉴别甲状腺结节性质准确有效的方法,具有重要的临床病理诊断作用。

Objective To investigate the role of immunohistochemistry in the diagnosis of thyroid nodule.Methods A retrospective analysis was made on 526 thyroid nodule specimens from Hangzhou Hospital of Traditional Chinese Medicine from January 2016 to December 2019.There were 98 cases of nodular goiters,30 cases of Hashimoto thyroiditis,198 cases of thyroid adenomas,200 cases of papillary thyroid cancer(PTC).Immunohistochemistry used antibodies including MC,cyclin D1,CD56 and TTF-1.To observe the difference of the expression of this immunohistochemical combination between thyroid benign lesions and PTC.Results There was no significant difference in TTF-1 expression between PTC and benign thyroid lesions(P>0.05).The expressions of CD56 in PTC were significantly lower than those in benign thyroid lesions(P<0.001),and the expressions of MC and cyclin D1 in PTC were significantly higher than those in benign thyroid lesions(P<0.001).The sensitivity,specificity,positive predictive value and negative predictive value of MC,CD56 and cyclin D1 in the diagnosis of PTC were 84.5%,99.1%,98.5% and 90.4% respectively.There were no significant differences in the expressions of TTF-1,CD56,MC and cyclin D1 in PTC patients at different gender,age,tumor size,N stage and M stage(P>0.05).Conclusion The combination of MC,cyclin D1,CD56 and TTF-1 by immunohistochemistry is an accurate and effective method for the identification of thyroid nodule properties before surgery,and has important clinicopathological diagnostic role.