摘要
目的:探讨细胞核形态评分联合细胞周期蛋白D1(cyclin D1)免疫细胞化学染色,用于甲状腺细胞病理学Bethesda报告系统(TBSRTC)分类中不确定类别(Ⅲ~Ⅴ级)病变诊断的可行性。方法:收集2018年12月至2022年4月北京医院病理科共118例有组织病理学随访结果,术前穿刺细胞学诊断为TBSRTCⅢ、Ⅳ及Ⅴ级的甲状腺滤泡上皮病变。行细胞形态学观察及涂片退染cyclin D1免疫细胞化学染色。利用受试者工作特征曲线(ROC)和ROC曲线下面积(AUC)评估简化的细胞核形态评分及cyclin D1诊断甲状腺恶性肿瘤的最佳临界值。通过交叉列联表评价各指标的特异度、灵敏度、阳性预测值(PPV)和阴性预测值(NPV),ROC曲线分析评价简化核形态评分联合cyclin D1的诊断准确性。结果:核沟、核内包涵体及核淡染更易出现于恶性/低危甲状腺结节(P=0.001,0.012,0.001)。简化的核形态评分的阳性阈值设定为2分,诊断甲状腺恶性/低危肿瘤的灵敏度高,其PPV为93.6%,NPV为87.5%,灵敏度为99.0%,特异度为50.0%。cyclin D1核染色阳性阈值设定为10%,诊断甲状腺恶性/低危肿瘤的PPV为100%,NPV为53.8%,灵敏度为88.5%,特异度为100%。联合核形态评分与cyclin D1免疫细胞化学,诊断甲状腺恶性/低危肿瘤的灵敏度为93.3%,PPV为100%,而特异度和NPV都保持在高水平(100%和66.7%)。与单独使用上述检测方法相比,核形态评分联合cyclin D1免疫细胞化学,辅助细针穿刺细胞学诊断甲状腺恶性/低危肿瘤的准确性提高至94.1%。结论:对细针穿刺细胞学诊断不确定的病例,结合简化核形态评分及cyclin D1免疫细胞化学染色,可以提高细胞学在诊断甲状腺恶性/低危肿瘤中的准确性。这一辅助手段为细胞病理学医师提供了一个简单、准确和方便的诊断方法,同时减少了外科不必要的甲状腺切除手术。
ObjectiveTo assess the feasibility of nuclear score combined with cyclin D1 immunocytochemistry in classifying indeterminate thyroid nodules with fine-needle aspiration(FNA)cytological diagnosis of Bethesda categoryⅢ-Ⅴ.MethodsA consecutive cohort of 118 thyroid FNA specimens with indeterminate diagnosis(TBSRTC categoryⅢ-Ⅴ)and available histopathologic follow-up data were collected between December 2018 and April 2022 at the Department of Pathology,Beijing Hospital,China.These cases were subjected to cytological evaluation and cyclin D1 immunocytochemistry.The optimal cut-off points of a simplified nuclear score and the percentage of cyclin D1-positive cells for the diagnosis of malignancy or low-risk neoplasm were determined using the receiver operating characteristic(ROC)curves and area under the ROC curve(AUC).The specificity,sensitivity,positive predictive value(PPV)and negative predictive value(NPV)of nuclear score and cyclin D1 immunostaining were evaluated from the crosstabs based on cut-off points.The diagnostic accuracy of simplified nuclear score combined with cyclin D1 immunostaining was estimated using ROC curve analysis.ResultsNuclear grooves,intra-nuclear inclusions and chromatin clearing were more commonly found in malignancy/low-risk neoplasms than benign lesions(P=0.001,P=0.012 and P=0.001 respectively).A cut-off point of≥2 for the simplified nuclear score was sensitive for defining malignancy/low-risk neoplasm,and its PPV,NPV,sensitivity and specificity were 93.6%,87.5%,99.0%and 50.0%respectively.A positive cut-off point of 10%positive thyroid cells in cyclin D1 immunostaining demonstrated sensitivity of 88.5%,specificity of 100%,PPV of 100%and NPV of 53.8%for correctly detecting thyroid malignancy or low-risk neoplasm.The sensitivity and PPV of simplified nuclear score combined with cyclin D1 immunostaining were 93.3%and 100%,respectively.Both specificity and NPV were maintained at high levels(100%and 66.7%,respectively).The diagnostic accuracy of simplified nuclear score combined with cyclin D1 immunostaining in detecting thyroid malignancy/low-risk neoplasm was increased to 94.1%compared to using either of them alone.ConclusionsCombing simplified nuclear score and cyclin D1 immunostaining on FNA cytology specimens can increase the diagnostic accuracy in classifying thyroid nodules of indeterminate cytological categories.Thus,this supplementary approach provides a simple,accurate,and convenient diagnostic method for cytopathologists so that may reduce unnecessary thyroidectomies.
作者
何淑蓉
刘龙腾
陈荣明
汪梦鸽
胡松涛
缪刚
陈岚
刘东戈
He Shurong;Liu Longteng;Chen Rongming;Wang Mengge;Hu Songtao;Miao Gang;Chen Lan;Liu Dongge(Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing 100730,China;Department of Pathology,the People's Hospital of Changfeng County,Anhui Province,Hefei 231100,China;Department of Pathology,Beijing Shijingshan Hospital,Beijing 100043,China;Department of General Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Science,Beijing100730,China)
出处
《中华病理学杂志》
CAS
CSCD
北大核心
2023年第7期696-701,共6页
Chinese Journal of Pathology
基金
北京医院临床课题(BJ-2019-155)。
