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Thyroperoxidase immunodetection for the diagnosis of malignancy on fine-needle aspiration of thyroid nodules

  • International Association of Endocrine Surgeons—Manuscripts Presented at the 35th World Congress of the International Society of Surgery, Hong Kong, August 1993
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Abstract

We have previously demonstrated that in 95.6% of malignant thyroid tumors the enzyme thyroid peroxidase (TPO) presents antigenic changes detectable by a monoclonal antibody termed MoAb47. The aim of this study was to investigate the interest of TPO immunodetection for the diagnosis of malignancy on fine-needle aspiration biopsy (FNAB) of thyroid nodules. The study was performed on 300 patients. Slides of FNAB aspirate were air-dried and stained by anti-TPO-MoAb47. According to the percentage of TPO-positive epithelial cells, patients were divided into two groups: benign (<80%) and malignant (<80%). In 279 cases additional slides were available for Giemsa stain and standard cytology. All the patients were operated on, and the final diagnosis was recorded as benign in 248 cases (183 macrofollicular nodules, 23 microfollicular adenomas, 18 atypical adenomas, 11 oncocytomas, 11 thyroiditis, 2 Graves' disease) and malignant in 52 cases (44 papillary carcinomas and 8 follicular carcinomas). Samples from 215 of 248 benign nodules yielded 80% to 100% TPO-positive cells, whereas samples from all malignant tumors yielded less than 80% positive cells. The sensitivity of TPO staining for diagnosis of malignancy was thus 100%, its specificity 86.7%, and its overall accuracy 89%. With conventional cytology, sensitivity, specificity, and accuracy were 91.6%, 79.2%, and 81.0%, respectively. We conclude from this study that TPO staining with MoAb47 should become an essential adjunct in the preoperative cytologic diagnosis of thyroid nodules.

Résumé

Nous avons démontré que la thyroperoxydase (TPO) présente des modifications détectables par un anticorps monoclonal MoAb47 dans 95.6% des tumeurs malignes de la thyroïde. Le but de cette étude était d'apprécier la valeur de l'immunodetection de la TPO pour le diagnostic de malignité des nodules thyroïdiens par cytoponction à l'aiguille fine. L'étude a porté sur 300 patients. Les lames ont été séchées à l'air et mises en incubation avec l'anti TPO-MoAb47. Selon le pourcentage de cellules épithéliales TPO-positives, les nodules ont été divisés en deux groupes: bénin (>80%) et malin (<80%). Dans 279 cas, d'autres lames ont été utilisées pour des colorations Giesma et une cytologie standard. Tous les patients ont été opérés et le diagnostic final a été bénin dans 248 cas (183 nodules macrovésiculaires, 23 adénomes microvésiculaires, 18 adénomes typiques, 11 oncocytomes, 11 thyroïdites, 2 maladies de Basedow) et malin dans 52 cas (44 cancers papillaires et 8 cancers folliculaires). Les lames provenant de 215/248 nodules bénins ont montré 80% à 100% de cellules TPO-positives alors que les lames de toutes les tumeurs malignes ont montré moins de 80% de cellules positives. La sensibilité de l'immunodetection TPO pour le diagnostic d'une tumeur maligne est donc de 100%, sa spécificité de 86.7% et sa fiabilité globale de 89%. Par la cytologie traditionnelle, la sensibilité, la spécificité et la fiabilité ont été de 91.6%, 79.2% et de 81%, respectivement. Nous concluons que l'immunodetection TPO avec MoAb47 peut devenir un complément essentiel dans le diagnostic cytologique préopératoire des nodules de la thyroïde.

Resumen

En publicaciones anteriores hemos demostrado que e 195.6% de los tumores malignos de la glándula tiroides, la enzima peroxidasa tiroidea (TPO) presenta cambio antigénicos detectables mediante un anticuerpo monoclonal denominado MoAb47.

El propósito del presente estudio fue investigar el valor de la immunodetección de TPO para el diagnóstico de malignidad en aspiración-biopsia con aguja fina en nódulos tiroideos.

El estudio fue realizado en 300 pacientes. Las placas histologicas fueron secadas al aire y coloreadas con anti TPO-MoAb47. Según el porcentaje de células epiteliales TPO-positivas, los pacientes fueron divididos en dos grupos: benignos (>80%) y malignos (<80%). En 279 casos se colorearon láminas adicionales con Giemsa para citología estándar.

Todos los pacientes fueron operados y el diagnóstico final fue registrado como benigno en 248 casos (183 nódulos macrofoliculares, 23 adenomas microfoliculares, 18 adenomas atípicos, 11 oncocitomas, 11 tiroiditis, 2 enfermedad de Graves) y maligno en 52 casos (44 carcinomas papilares y 8 carcinomas foliculares). Las muestras de 215/248 nódulos benignos revelaron 80% a 100% células TPO-positivas, en tanto que las muestras de todos los tumores malignos revelaron menos de 80% de células positivas. La sensibilidad de la coloración TPO para el diagnóstico de malignidad, fue, por lo tanto, 100% su especifidad 86.7% y su certeza global 89%. Con citología convencional, la sensibilidad, especificidad y certeza fueron respectivamente 91.6%, 79.2% y 81%. Nuestra conclusión es que la coloración TPO con MoAb47 debe convertirse en un elemento esencial adyuvante en el diagnóstico citológico de los nódulos tiroideos.

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Authors and Affiliations

  1. Department of Endocrine Surgery, University Hospital La Timone, Bd. Jean Moulin, 13385, Marseille Cedex 05, France

    Jean-Francois Henry M.D., Anne Denizot M.D., Alberto Porcelli M.D. & Marcelo Villafane M.D.

  2. Department of Pathology, University Hospital Nord, Bd. P. Dramard, 13015, Marseille, France

    Patricia Zoro M.D., Stéphane Garcia M.D. & Cathérine De Micco M.D.

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  1. Jean-Francois Henry M.D.
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Henry, JF., Denizot, A., Porcelli, A. et al. Thyroperoxidase immunodetection for the diagnosis of malignancy on fine-needle aspiration of thyroid nodules. World J. Surg. 18, 529–534 (1994). https://doi.org/10.1007/BF00353756

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