摘要
目的 探讨超声图像特征与免疫组织化学(IHC)标志物在预测甲状腺C-TIRADS4类结节恶性风险因素中的价值。方法 选取宝鸡市人民医院2023年9月至2024年9月经超声检查的80例分类为C-TIRADS 4类甲状腺结节,均行超声引导下粗针穿刺活检,并对活检组织固定、石蜡包埋、切片染色。分析超声图像特征并与IHC标志物NCAM-1、CK19、Galectin-3、HBME-1蛋白表达进行对比分析,比较其在甲状腺C-TIRADS4类结节中的诊断价值。应用二元Logistic回归方程分析超声图像特征与免疫组化标志物诊断甲状腺C-TIRADS4类结节恶性风险的独立危险因素,以P<0.05为差异有统计学意义。结果 80例甲状腺C-TIRADS4类结节中良性组结节32例(结节性甲状腺肿21例、滤泡性腺瘤11例),恶性组结节48例(乳头状癌46例、滤泡癌2例)。低/极低回声、垂直位、边缘模糊/分叶或不规则3种恶性超声图像特征在甲状腺C-TIRADS4类结节良性组与恶性组间比较,差异均有统计学意义(P<0.05)。IHC蛋白标志物NCAM-1、CK19、Galectin-3及HBME-1在甲状腺C-TIRADS4类结节中良性组与恶性组间阳性表达率相比,差异均有统计学意义(χ^(2)=25.871、21.834、31.479、49.375,P<0.05)。超声图像特征中5种恶性征象与IHC 4种标志物在甲状腺C-TIRADS4类结节中的诊断效能比较,HBME-1的诊断效能较高AUC(95%CI)为0.891[95%CI(0.807~0.975)],结节微钙化情况诊断效能较低AUC(95%CI)为0.589[95%CI(0.464~0.713)]。多因素二元Logistic回归分析显示,结节生长方式[OR95%CI:50.646(1.378~1861.545)]、CK19[OR95%CI:0.010(0.000~1.597)]、Galectin-3[OR95%CI:0.011(0.000~0.316)]及HBME-1[OR95%CI:0.003(0.000~0.065)]可作为判断甲状腺C-TIRADS4类结节恶性风险的独立危险因素(P<0.05),结节内部回声、结节边缘、NCAM-1不能作为判断甲状腺C-TIRADS4类结节恶性风险的独立危险因素(P>0.05)。结论 低/极低回声、垂直位生长、边缘不规则/分叶或模糊3个甲状腺结节恶性征象与4种免疫组化标志物NCAM-1、CK19、Galectin-3、HBME-1在甲状腺C-TIRADS4类结节中的表达及鉴别甲状腺结节的性质具有重要临床价值,结节生长方式、CK19、Galectin-3及HBME-1可作为判断甲状腺C-TIRADS4类结节恶性风险的独立危险因素。
Objective To investigate the value of ultrasonic image features and immunohistochemical(IHC)markers in predicting malignant risk factors of thyroid C-TIRADS4 nodules.Methods A total of 80 patients with C-TIRADS type 4 thyroid nodules examined by ultrasound from September 2023 to September 2024 in Baoji People's Hospital were selected and classified as C-TIRADS type 4 thyroid nodules.All patients underwent ultrason-guided coarse needle biopsy and biopsy tissue fixation,paraffin embedding and section staining.The ultrasonographic characteristics and the expression of IHC markers NCAM-1,CK19,Galectin-3 and HBME-1 were analyzed to compare their diagnostic value in C-TIRADS4 thyroid nodules.Binary Logistic regression equation was used to analyze the independent risk factors of ultrasonic image features and immunohistochemical markers for the diagnosis of malignant risk of C-TIRADS4 thyroid nodules.P<o.05 was considered as statistically significant difference.Results There were 32 benign nodules(21 nod-ular goitre,11 follicular adenoma)and 48 malignant nodules(46 papillary carcinoma,2 follicular carcinoma)among the 80 cases of C-TIRADS4 thyroid nodules.Three kinds of malignant ultrasound images of low/very low echo,vertical position,blurred edge/lobed or irregular were compared between benign and malignant thyroid C-TIRADS4 nodule groups,and the differences were statistically significant(P<0.05).The positive expression rates of IHC protein markers NCAM-1,CK19,Galectin-3,and HBME-1 in thyroid C-TIRADS4 nodules were significantly different between the benign and malignant groups(x²=25.871,21.834,31.479,49.375,P<0.05).Comparing the diagnostic efficacy of 5 malignant signs and 4 markers of IHC in C-TIRADS4 thyroid nodules,HBME-1 had higher diagnostic efficacy AUC(95%CI)of 0.891[95%CI(0.807~0.975)],while nodular microcalcification had lower diagnostic efficacy AUC(95%CI)of 0.589[95%CI(0.644~0.713)]J.Multifactor binary Logistic regression analysis showed that nodule growth pattern[OR95%CI:50.646(1.378~1861.545)],CK19[OR95%CI:0.010(0.000~1.597)J,galectin-2[OR95%CI:0.011(0.000~0.316)Jand HBME-1[OR95%CI:0.003(0.000~0.065)Jwere independent risk factors for C-TIRADS4 type thyroid nodules(P<O.05),but internal echo,nodule margin and NCAM-1 were not independent risk factors for C-TIRADS4 type thyroid nodules(P>0.05).Conclusion Three malignant signs of thyroid nodules,including low/very low echo,vertical growth,irregular edge/lobulation or blurred,and the expression of four immunohistochemical markers,NCAM-1,CK19,galectin-3 and HBME-1,in C-TIRADS4 thyroid nodules and the identification of the nature of thyroid nodules have important clinical value.Nodular growth pattern,CK19,Galectin-3 and HBME-1 can be used as independent risk factors to judge the risk of C-TIRADS4 thyroid nodules.
作者
马蓉
邵春晖
何柳
MA Rong;SHAO Chunhui;HE Liu(Department of Pathology,Baoji People's Hospital,Baoji,Shanri 721000,China;Department of Ultrasound Medicine,Baoji People's Hospital,Baoji,Shanri 721000,China;Department 2 of Ultrasound Medicine,Baoji Central Hospital,Baoji,Shanri 721008,China)
出处
《中国实验诊断学》
2025年第5期551-558,共8页
Chinese Journal of Laboratory Diagnosis
基金
宝鸡市卫生健康委员会2024年度科研计划立项课题(2024-052)
宝鸡市卫生健康委员会2025年度科研计划立项课题(2025-079)。
