CK19、CK20在甲状腺乳头状癌诊断中的应用价值

目的：探讨甲状腺癌中CK19、CK20蛋白的表达，提高甲状腺的诊断与鉴别诊断水平。方法：应用免疫组化染色对70例甲状腺癌（15例经典型乳头状癌、34例滤泡型乳头状癌、3例Warthin乳头状癌、2例透明细胞型乳头状癌、例柱状细胞型乳头癌、15例滤泡性癌），10例甲状腺腺瘤、10例结节性甲状腺肿和5例标本甲状腺炎中CK19、CK20的表达进行观察。结果:CK19在甲状腺疾病中的表达：55例乳头状癌中，53例为中、强阳性，2例为弱阳性；15例滤泡性癌中，13例为阴性、弱阳性，2例为中、强阳性，两者之间差异存在显著性（P＜0．05）。各癌旁滤泡、10例滤泡性腺瘤、10例结节性甲状腺肿的滤泡、5例桥本甲状腺炎也主要为阴性、弱阳性，个别为中等阳性。对CK20的表达，各型甲状腺乳头状癌、滤泡性癌、癌旁滤泡及滤泡状癌和乳头状增生、多灶性分布的甲状腺泡型乳头状癌和各种滤泡性病变有帮助，可提高甲状腺良恶性病变诊断的准确率及鉴别诊断水平。CK20对鉴别诊断的帮助不大。

Diagnostic utility of cytokeratin 19,20 in the papillary carcinoma of the thyroid gland

Purpose To analyse the relation between the expression of CK19, CK20 and thyroid carcinomas. Methods Immunohistochemical staining was perform on formalin fixed, paraffin ermbeded sections from 70 carcinomas, 10 follicular adenomas, 10 multinodular goiters, 5 Hashimoto thyroiditis. Results As to immunohistochemical reaction to CK19, of 55 papillary carcinomas, 53 showed moderate to strong positive, 2 showed weak positive. Of 15 follicular carcinomas, 13 were negative to weak positive, 2 were moderate to strong positive. They showed remarkably difference( P <0 05). Follicular areas of surroundjng thyroid carcinoma, 10 follicular adenomas,10 multinodular goiters, 5 Hashimoto thyroiditis were almost negative to weak positive, and only minority showed moderate positive. As for immunohistochemical reaction to CK20, all cases (papillary carcinoma, follicular carcinoma, surrounding follicular of carcinoma, follicular adenomas, multinodular goiters, Hashimoto thyroiditis) were negative to weak positive,and hence it did not showed distinction. Conclusions CK19 may be helpful in differentiating papillary carcinoma from papillary hyperplastic, multifocal follicular carcinoma, and all benign follicular lesions. CK20 may not be helpful in differential diagnosis of thyroid lesions.