桥本病合并甲状腺癌串TPO、CK-19、Galectin-3和HBME-1的细胞学诊断意义

目的评价桥本病（HD）合并甲状腺癌中甲状腺过氧化物酶（TPO）、细胞角蛋白-19（CK119）、半乳糖凝集素-3（Gal-3）和间皮细胞表面抗原-1（HBME-1）的细胞免疫学诊断意义。方法将甲状腺肿瘤分为恶性组（M组）和良性组（B组，包括腺瘤组和结节组）；根据淋巴细胞浸润。分为HD合并甲状腺肿瘤组和单纯甲状腺肿瘤组。取肿瘤外正常甲状腺为对照，检测针吸细胞涂片TPO、CK-19、Gal-3和HBME-1的表达水平。结果51例肿瘤患者中合并HD者，M组与B组的差异无统计学意义（P〉0．05）。M组淋巴结转移13例。合并HD组与单纯组的差异无统计学意义（P〉0．05）。在HD合并结节组内，M组表达TPO、Gal-3和HBME-1阳性率高于B组，但CK-19表达差异无统计学意义（Z=-0．327，P〉0．05）。标记物中，单项诊断以Gal-3的正确指数（YI）最高（81．11％）；两项联合，TPO＋Gal-3和TPO＋HBME-1时YI分别为83．95％和81．37％；三项联合，TPO＋Gal-3＋HBME-1时YI达86．54％。在HD合并肿瘤亚组。CK-19的阴性预测值为0。结论合并HD与否对甲状腺肿瘤术前评估意义不大。Gal-3细胞免疫诊断价值最大。HD合并肿瘤时，CK-19假阳性率高。

Diagnostic Hashimoto Hangzhou,value of TPO,CK-19, Gal-3 and HBME-1 in fine needle aspiration cytological specimens for thyroid carcinoma with s disease

Objective To investigate the diagnostic value of thyroperoxidase （TPO）, cytokeratin-19 （CK-19）, galectin-3 （Gal-3） and HBME-1 in fine needle aspiration cytological specimens for thyroid carcinoma （TC） with Hashimoto＇s disease（HD）. Methods Fifty one cases with thyroid neoplasm were divided into malignant tumors （group M） and benign tumors （group B）, and further divided into with HD group and without HD group. Fine needle aspiration specimens were taken in each group and specimens around the nodule of thyroid was also taken as control. TPO, CK-19, Gal-3 and HBME-1 were examined by immunocystochemical method in 51 specimens of thyroid neoplasm and 24 control specimens. Results There was no difference in prevalence of HD between group M and group B （P〉0.05）. In group M, 13 cases affected lymph node metastasis, there was no significant difference in metastasis rate between HD and without HD groups （P〉0.05）. In tumor with HD, positive expression rate of TPO, Gal-3 and HBME-1 was significantly higher in group M than that in group B, while not for CK-19 （Z = -0.327, P = 0.786）. The Youdon＇s index （YI） of Gal-3 was 81.11%, YI of TPO combined Gal-3, TPO combined HBME-land TPO＋Gal-3＋HBME-1 were 83.95%, 81.37% and 86.54%, respectively. Conclusion Our data showed that coexisting with HD may not be helpful for preoperative evaluation in patients with thyroid nodules. Gal-3 may be the most useful immunocytochemical marker for diagnosis of thyroid carcinoma with Hashimoto＇s disease and CK-19 is least helpful.