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IMMUNOCYTOCHEMICAL AND MOLECULAR HELP IN THYROID LIQUID BASED CYTOLOGY.
G. Simone, M. Liuzzi, G. Achille, S. Russo, F. Palma, G. Giannone, V. Rubini, C. Quero, G. Grammatica.
NCI “Giovanni Paolo II” - Bari ( Italy)
22nd EUROPEAN CONGRESS OF PATHOLOGY NATIONAL CONGRESS SIAPEC-IAP Florence, September 4-9 2009
INTRODUCTION
Fine Needle Cytology (FNC) is the most important tool in the diagnosis of thyroid nodules.It has been demonstrated that Liquid Based Cytology (LBC) improves the quality of the smears and the diagnostic accuracy, also because of well preserved cellularity useful to immunocytochemical (ICA) or molecular assays (MA). The aim of the study is to verify the potential help of ICA or MA on LBC, when applied on indeterminate or malignant Thyroid FNCs.
MATERIAL AND METHODS
101 Patients who underwent thyroid FNCs entered the study 89 females and 12 males (mean age: 44.7; Fem 46.4;
Males 43); Echography: 72 nodules were single, whereas 29 nodules were the major in multinodular thyroids
The material was processed in Thin Prep 2000 TM.
48 Samples were available for HBME-1 using ICA 48 Different samples were available for BRAF gene mutation (V600E) detection, using MASA technique 5 Samples of the same Patients were available for HBME-1
and BRAF determination 101 FNCs were classified according to SIAPEC classification.
Surgical samples of all FNCs were available for cyto-histological correlation
Patients N.
Females 89
Males 12
Mean Age 44.7
Single Nodule 72
Multinodular 29
Assays N.
FNCs 101
HBME-1 assays 48
BRAF assays 48
HBME-1 and BRAF assays
5
MATERIAL AND METHODS
RESULTS
Out of 101 FNCs, 75 were classified as “Follicular Lesions” (THY 3) and 26 as Papillary Thyroid Carcinoma (PTC). The cyto-histological correlation showed an Overall Agreement (O.A.) of 89.1% (p<0.001) (Tab.1). In 53 LBCs, the prevalence of HBME-1 expression was 45.2%(Tab. 2) and the O.A. with histological diagnosis resulted 87%, versus 91% according to Cytology (Tab 3).In the other 53 cases, the prevalence of BRAF mutation was 24.5% (Tab. 4) and the O.A. with histological diagnosis resulted 87% (p <0.001), the same than according to Cytology (Tab 5).The Positive Predictive Value for PTC was 96.2%, 70.8% and 100% for Cytology, HBME-1/ICA and BRAF/MA, respectively. In 5 cases, where both HBME-1 and BRAF mutation were investigated, 2 PTCs were HBME-1 positive and BRAF mutated whereas, the remaining 3 cases (2 Adenomas and 1 Hyperplastic Nodule) were negative for both the markers.
Table 1. CYTO-HISTOLOGICAL CORRELATION IN 101 THYROID FNCs
Histology
Benign Malignant TOT
Cytology Follicular 65* 10 75
Malignant 1 25 26
TOT 66 35 101
Cytology PPV = 96.2%
O.A.: 89.1%; p < 0.001
*36 Thy 3 resulted in Adenomas and 29 in Hyperplastic Nodules in adenomatous goitre.
Table 2. HBME-1/LBC VERSUS HISTOLOGY: CORRELATION OF 53 CASES
Histology
Benign Malignant TOT
HBME-1/
L B C
Negative 29 0 29
Positive 7* 17 24
TOT 36 17 53
PPV = 70.8%
O.A. : 87%; p < 0.001
*The 7 FNCs resulted in: 2 IPM Follicular Lesions, 2 Adenomas and 3 hyperplastic nodules)
Table 3. CYTO-HISTOLOGICAL CORRELATION OF 53 CASES WITH HBME-1 IMMUNOCYTOCHEMICAL ASSAY
PPV = 92.9%
O.A. = 91%; p<0.001
*1 False Positive case was HBME-1 Negative
Histology
Benign Malignant TOT
Cytology Follicular 35 4 39
Malignant 1* 13 14
TOT 36 17 53
Table 4. BRAF mutation VERSUS HISTOLOGY: CORRELATION ON 53 CASES
Histology
Benign Malignant
TOT
BRAF Wild-type 33 7 40
Mutated 0 13 13
TOT 33 20 53
PPV = 100%
O.A. = 87%; p<0.001
Table 5. CYTO-HISTOLOGICAL CORRELATION OF 53 CASES WITH BRAF DETERMINATION
Histology
Benign Malignant TOT
Cytology Follicular 33 7 * 40
Malignant 0 13** 13
TOT 33 20 53
PPV = 100%
O.A. = 87%; p<0.001
*4/7 cases showed BRAF-mutation;** 4/13 cases resulted wild type
1a 1b
Fig. 1a: Inderterminate Thyroid FNA (See also * in Table 5 ) resulted in papillary cancer at histology, as observed in thin layer (LBC). Fig. 1b: The same case of 1a, as observed in conventional smear (Thin Prep, Cytic Co., Papanicolau Stain, 400x)
Case 1
1c1d
Fig. 1c: Histological control: Papillary Thyroid Cancer (HE 400x)Fig. 1d: BRAF mutation as detected by PCR, Mutant Allele Specific Amplification (MASA) technique: the electrophoretic run
Case 2
PTC (Fig. 2a) and HBME1 Immunoreactivity (Fig. 2b) on LBC and on the corresponding surgical sample (Fig. 2c and 2d)
2a 2b
2c 2d
Case 2: V600E exon 15 BRAF mutation as detected by direct sequencing
Our study showed that Immunocytochemical and molecular assays can be successfully applied on monolayered smears, on well preserved cells obtained by LBC; they could increase diagnostic accuracy in thyroid FNC.However, these markers evidenced some limits in relation to the lower specificity and PPV of HBME1 (Positive also in follicular adenomas) as well as for the low sensitivity of the BRAF mutation.In our experience, the HBME 1 appears to be still usefull in reducing the diagnosis of “ Indeterminated Nodule”.Moreover, in particular follicular lesions, when a diagnosis has to be confirmed, MASA technique showed to be an available tool, according to the absolute PPV of the BRAF mutation in PTC
CONCLUSIONS
22nd EUROPEAN CONGRESS OF PATHOLOGY NATIONAL CONGRESS SIAPEC-IAP Florence, September 4-9 2009