Abstract
Background: Papillary thyroid carcinoma (PTC)is the most common form of thyroid cancer, however, it is often difficult to differentiate PTC from benign papillary hyperplasia of the thyroid gland based on their morphology. Immunohistochemical markers can decrease the diagnostic dilemma, effectively pointing out cases with more chance of becoming malignant.
The objective of my study is to understand the utility of cytokeratin-19 and Galectin-3 in the diagnosis of papillary thyroid carcinoma
Method: A total of 54 samples from benign group and 54 samples from histopathologically proven papillary thyroid carcinoma were collected. Histomorphological features and their immunohistochemical expression of CK-19 and Galectin-3 were studied. Data thus obtained was analysed using software SPSS version17.0. Histopathological diagnosis was considered as the gold standard.
Results and Discussion: The 108 thyroid samples were diagnosed as follows; 30 Cases of multinodular goiter, 24 case of follicular adenoma, 19 cases of PTC classic variant, 17cases of follicular variant of papillary carcinoma, 17 cases of other variants of papillary thyroid carcinoma. Sensitivity, specificity and diagnostic accuracy of CK-19 being 94.4 %, 50% and 72.2%. respectively with a kappa value 0.481 .Positive predictive value of CK-19 was found to be 67.1% and negative predictive value of 84.4%. Sensitivity, specificity and diagnostic accuracy of Gal-3 being 72.2% 90.7% and 81.5% respectively with a kappa value 0.630. Positive predictive value was found to be 88.6% and negative predictive value was found to be 76.6%.By combined immunostaining of CK-19 and Gal-3 96.3% malignant nodules could be identified and 51.9% of benign nodules could be differentiated correctly.
Conclusion: In this study CK-19 was more sensitive while Galectin-3 was found to be more specific. when combined the sensitivity has increased to 96.3%.So if we use a panel of markers including CK-19 and galectin-3,it would help to pick out more cases of Papillary thyroid carcinoma so that early treatment can be given to such patients
Keywords: Immunohistochemistry; Galectin-3; CK-19; follicular adenoma; Multinodular Goiter; papillary thyroid carcinoma.
References
- Nikiforov YE. Thyroid tumors: classification and general considerations. Diagnostic Pathology and Molecular Genetics of the Thyroid volume 135. 2009:94-102.
- Enewold L, Zhu K, Ron E, Marrogi AJ, Stojadinovic A, Peoples GE, et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980-2005. Cancer Epidemiol Biomarkers Prev. 2009; 18: 784-791
- Tuttle RM, Ball DW, Byrd D, Dilawari RA, Doherty GM, Duh QY, et al. Thyroid carcinoma. J Natl Compr Canc Netw. 2010; 8: 1228-1274
- Nikiforov YE, Biddinger PW, Thompson LD, editors. Diagnostic pathology and molecular genetics of the thyroid: a comprehensive guide for practicing thyroid pathology. Lippincott Williams & Wilkins; 2012 Apr 20.
- Cady B. Staging in thyroid carcinoma. Cancer: Interdisciplinary International Journal of the American Cancer Society. 1998 Sep 1;83(5):844-7..
- Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993; 114: 1050-7; discussion 7-8.
- Shaha AR1, Loree TR, Shah JP. Prognostic factors and risk group analysis in follicular carcinoma of the thyroid. Surgery. 1995; 118: 1131-1136.
- Song Q, Wang D, Lou Y, Li C, Fang C, He X, Li J. Diagnostic significance of CK19, TG, Ki67 and galectin-3 expression for papillary thyroid carcinoma in the northeastern region of China. Diagnostic pathology. 2011 ;6(1):1.
- Mathew IE, Mathew A. Rising Thyroid Cancer Incidence in Southern India: An Epidemic of Overdiagnosis?. Journal of the Endocrine Society. 2017 Apr 4;1(5):480-7.
- Prasad ML, Huang Y, Pellegata NS, de la Chapelle A, Kloos RT: Hashimoto's thyroiditis with papillary thyroid carcinoma (PTC) - like nuclear alterations expresses molecular markers of PTC. Histopathology. 2004, 45: 39-46. 10.1111/j.1365-2559.2004.01876.x.
- Barroeta JE, Baloch ZW, Lal P, Pasha TL, Zhang PJ, LiVolsi VA. Diagnostic value of differential expression of CK19, Galectin-3, HBME-1, ERK, RET, and p16 in benign and malignant follicular-derived lesions of the thyroid: an immunohisto-chemical tissue microarray analysis. Endocrine pathology. 2006 Sep 1;17(3):225-34.
- de Matos LL, Del Giglio AB, Matsubayashi CO, de Lima Farah M, Del Giglio A, da Silva Pinhal MA. Expression of CK-19, galectin-3 and HBME-1 in the differentiation of thyroid lesions: systematic review and diagnostic meta-analysis. Diagnostic pathology. 2012 Dec;7(1):97.
- Guhamallik M, Sengupa S et al: Cytodiagnosis of thyroid lesions-usefulness and pitfalls: A study of 288 cases. J Cytol 2008; 25: 6-9.
- Mauro P, Jaime R, Roberta DP: Galectin-3 and HBME-1 expression in well differentiated thyroid tumors with follicular architecture of uncertain malignant potential. Mod Pathol 2005;18:541–6.
- de Matos PS, Ferreira AP :Usefulness of HBME-1, cytokeratin 19 and galectin-3 immu-nostaining in the diagnosis of thyroid malignancy Histopathology 2005;47:391–
- Laco J, Ryška A, Čáp J, Čelakovský P. Expression of galectin-3, cytokeratin 19, neural cell adhesion molecule and E-cadherin in certain variants of papillary thyroid carcinoma. Cesk Patol. 2008;44 (4):103-7.
- Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993;328:553-9
- Scognamiglio T, Hyjek E, Kao J, Chen YT. Diagnostic usefulness of HBME1, galectin-3, CK19, and CITED1 and evaluation of their expression in encapsulated lesions with questionable features of papillary thyroid carcinoma. Am J Clin Pathol. 2006; 126(5):700–8. doi: 10.1309/044V86JN2W3CN5YB
Corresponding Author
Dr C.S. Sakunthala Bhai
Professor and Head of the Department, Department of Pathology, Jubilee mission Medical College & RI
DOI: https://dx.doi.org/10.18535/jmscr/v7i2.28
