Accuracy of fine needle aspiration biopsy with and without the use of tumor markers in cytologically indeterminate thyroid lesions [Pouzdanost citološke punkcije sa i bez upotrebe tumorskih biljega kod citološki neodređenih promjena štitnjače]

Mateša, Neven and Šamija, Ivan and Kusić, Zvonko (2010) Accuracy of fine needle aspiration biopsy with and without the use of tumor markers in cytologically indeterminate thyroid lesions [Pouzdanost citološke punkcije sa i bez upotrebe tumorskih biljega kod citološki neodređenih promjena štitnjače]. Collegium Antropologicum, 34 (1). pp. 53-57. ISSN 0350-6134

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Abstract

We investigated if the use of two tumor markers, galectin-3 and CD44v6, could improve diagnostic accuracy of thyroid fine needle aspiration biopsy (FNAB) in cytologically indeterminate lesions (CIL). 351 patients with CIL [cellular follicular lesion/suspicious follicular neoplasm/suspicious Hürthle cell neoplasm (CFL/sFN/sHCN), Hürthle cell neoplasm (HCN), and follicular neoplasm (FN)] and surgical follow-up were investigated. 251 patients had FNAB diagnoses made without help of tumor markers and the rest of 100 patients had FNAB diagnoses made with a known expression of tumor markers determined by the reverse transcription (RT)-PCR. Risk of malignancy in all 351 patients with CIL was 6.8%. In the group with FNAB made without RT-PCR, there were 140 CFL/sFN/sHCN with the risk of malignancy of 4.2%, 92 FN with the risk of malignancy of 13.0%, and 19 HCN with the risk of malignancy of 5.2%. In the group with FNAB made with RT-PCR, there were 49 CFL/sFN/sHCN with the risk of malignancy of 2.0%, 40 FN with the risk of malignancy of 7.5%, and 11 HCN with the risk of malignancy of 9.0%. In the group with at least one positive tumor marker (N=69), the risk of malignancy was 3.1% for CFL/sFN/sHCN, 11.1% for FN, and 10.0% for HCN. In the group with negative tumor markers (N=31) there were no malignancies. The use of tumor markers, galectin-3 and CD44v6, determined by RT-PCR improves only sensitivity of thyroid FNAB in CIL. In most patients with CIL, and negative both tumor markers, conservative approach is advisable.

Abstract in Croatian

Istraživali smo da li upotreba dvaju tumorskih biljega, galektina-3 i CD44v6, može poboljšati pouzdanost citološke dijagnoze (CD) štitnjače kod citološki neodređenih nalaza (CNN) u pogledu malignosti. Analiziran je 351 pacijent s CNN [celularna folikularna promjena/suspektan folikularni tumor/suspektan Hürthleov tumor (CFP, sFT, sHT), Hürthleov tumor (HT) i folikularni tumor (FT)] kojemu je promjena kirurški odstranjena. Kod 251 pacijenta CD je postavljena bez upotrebe tumorskih biljega dok je kod ostalih 100 pacijenata dijagnoza postavljena uz poznatu vrijednost tumorskih biljega određenih uz pomoć RT-PCR. Rizik malignosti kod svih pacijenata s CNN bio je 6,8%. U skupini s CD postavljenom bez RT-PCR, bilo je 140 CFP/sFT/sHT uz rizik malignosti od 4,2%, 92 FT uz rizik malignosti od 13,0%, te 19 HT uz rizik malignosti od 5,2%. U skupini s CD postavljenom sa RT-PCR, bilo je 49 CFP/sFT/sHT uz rizik malignosti od 2,0%, 40 FT uz rizik malignosti od 7,5%, te 11 HT uz rizik malignosti od 9,0%. U skupini sa barem jednim pozitivnim biljegom (N=69), rizik malignosti bio je 3,1% za CFP/sFT/sHT, 11,1% za FT, te 10,0% za HT. U skupini sa negativna oba tumorska biljega (N=31) nije bilo malignih tumora. Može se zaključiti da upotreba tumorskih biljega, galektina-3 i CD44v6, poboljšava samo senzitivnost CD štitnjače kod CNN. Kod većine pacijenata sa CNN i negativna oba tumorska biljega može se preporučiti konzervativni pristup.

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