Twist基因蛋白表达在甲状腺乳头状癌诊断与鉴别诊断中的意义

目的探讨Twist基因蛋白在甲状腺乳头状癌中的表达状况,寻找更特异的标记物,用于甲状腺乳头状癌（PTC）与滤泡状腺瘤（FA）和良性乳头病变（BPL）的鉴别诊断。方法以50例PTC为研究组,以48例FA和47例BPL作对照组。在自制组织芯片上行免疫组织化学（SP法）标记,检测Twist基因蛋白和HBME-1,并以CK19进行对照。结果3种指标（Twist、HBME-1、CK19）阳性表达率：在PTC组分别为100％（48／48）、94．0％（47／50）和78．0％（39／50）;在FA组分别为0、6．7％（3／45）和0;在BPL组分别为7．0％（3／43）、2．1％（1／47）和0。PTC组分别与FA和BPL组比较差异均有统计学意义（P=0．000）。3种指标在鉴别诊断甲状腺良、恶性病变的灵敏度分别为：100％、96．4％和97．7％,特异度分别为：94．0％、95．7％和95．1％,准确度分别为：78．0％、100％和91．9％。结论Twist可应用于辅助诊断PTC,并可应用在对FA或BPL的鉴别诊断。

Expression of Twist in papillary thyroid carcinomas and its roles in differential diagnosis

OBJECTIVE: To study Twist expression in thyroid papillary carcinoma (PTC) by immunohistochemistry and to assess its usefulness as marker in the differential diagnosis of PTC, follicular adenomas (FA) and benign papillary lesions (BPL). METHODS: Fifty cases of PTC, 48 cases of FA and 47 cases of BPL were evaluated using manual tissue chip and SP immunohistochemical stain to detect the expression of Twist and HBME-1, and comparing the staining to that of cytokeratin 19 (CK19). RESULTS: In PTC, positive rates of Twist, HBME-1 and CK19 were 100% (48/48), 94.0% (47/50) and 78.0% (39/ 50) respectively; in FA, positive rates were 0, 6.7% (3/45) and 0 respectively; in BPL, positive rates were 7.0% (3/34), 2.1% (1/47) and 0, respectively. The differences between PTC and FA and between PTC and BPL were both statistically significant (P = 0. 000). The sensitivity of Twist, HBME-1 and CK19 was 100%, 94.0% and 78.0%; the specifity was 96.4%, 95.7% and 100%; overall accurary was 97.7%, 95.1% and 91.9%, respectively. CONCLUSIONS: Positive rates of Twist is higher than the other markers in PTC. Immunohistochemical staining of Twist has important significance in the differential diagnosis of thyroid lesions. Twist immunohistochemistry maybe helpful in diagnosis and differential diagnosis of PTC.