Journal List > J Korean Thyroid Assoc > v.8(1) > 1056587

Jung, Choi, Lee, and Park: Immunohistochemical and Molecular Markers Associated with Differentiated Thyroid Carcinoma

Abstract

In the last decade, conventional diagnosis of thyroid nodules largely depended on fine-needle aspiration (FNA) and ultrasound. However, FNA has a limited ability to distinguish between benign and malignant lesions, especially in cases with indeterminate cytology. Although the clinical course of differentiated thyroid carcinoma is believed to be favorable, delayed diagnosis can make its clinical management difficult. Many immunohistochemical (IHC) or molecular adjunctive markers have been tested to improve the diagnostic accuracy for thyroid nodules. The common IHC markers galectin-3, Hector Battifora mesothelial-1, and cytokeratin-19 are used alone or as part of panels for both FNA and analysis of surgical specimens. A novel IHC marker, podoplanin, was recently introduced as an adjunctive marker for thyroid cancer diagnosis and prognosis and is associated with the progression of papillary thyroid carcinoma (PTC). Several researchers have identified molecular markers to increase the diagnostic accuracy of thyroid lesions of undetermined significance. Four promising molecular markers have been proposed and thoroughly investigated: B-type Raf kinase (BRAF) and RAS, rearranged in transformation/PTC (RET/PTC), paired box gene 8 (Pax8)/peroxisome proliferator-activated receptor gamma (PPAR γ). BRAF mutations can be measured by immunohistochemistry using an antibody specific to the mutated protein. In this review, we focused on the limitations of current diagnostic tools and on determining the application of the above-mentioned markers to thyroid nodule diagnosis.

References

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Fig. 1.
Galectin-3 immunostaining. (A) Galectin-3 is diffusely expressed in papillary thyroid carcinoma. It is localized in both the cytoplasm and nuclei (×400). (B) Focal expression of galectin-3 is detected in follicular thyroid carcinoma (×200). (C) Galectin-3 is not detected in follicular adenoma (×200).
jkta-8-50f1.tif
Fig. 2.
HBME-1 immunostaining. (A) Papillary thyroid carcinoma exhibits a strong membranous staining (×200). (B) Follicular thyroid carcinoma exhibits a diffuse cytoplasmic staining (×200). (C) Follicular adenoma shows focal expression of HBME-1 (×200).
jkta-8-50f2.tif
Fig. 3.
CK-19 immunostaining. (A) Papillary thyroid carcinoma exhibits a diffuse expression of CK-19 (×200). (B) Focal expression of CK19 is detected in follicular thyroid carcinoma (×200). (C) CK-19 is not detected in follicular adenoma (×200).
jkta-8-50f3.tif
Fig. 4.
BRAF staining in papillary thyroid carcinoma. A diffuse expression can be distinctively observed in both the cytoplasm and nuclei (×200).
jkta-8-50f4.tif
Table 1.
Immunohistochemical detection of galectin-3 in thyroid surgical specimens
Normal CLT NH FA PTC FTC PDTC ATC
Fernandez et al.23) 0 (0) - 0 (0) 0 (0) 18/18 (100) 4/8 (50) 2/3 (67) 5/5 (100)
Herrmann et al.19) - - 0 (0) 3/8 (37) 22/34 (64) 2/3 (67) - -
Kovacs et al.20) - 7/7 (100) - 4/19 (21) 19/20 (95) 7/10 (70) - -
Weber et al.71) - - - 4/13 (31) 22/24 (92) 4/9 (44) - -
Prasad et al.33) 0 (0) - 16/29 (55) 2/21 (9) 63/67 (94) 4/6 (67) - 4/4 (100)
Oestreicher-Kedem et al.72 - - - 7/15 (47) 15/18 (83) 7/11 (64) - -
Cvejic et al.21) - - - - 169/202 (84) - - -
Bartolazzi et al.22) 0/75 (0) 2/4 (50) 0/50 (0) 5/132 (4) 195/201 (97) 54/57 (95) 13/20 (65) 18/20 (90)
Saggiorato et al.29) - - - 3/50 (6) 39/39 (100) 16/19 (84) - -
Park et al.9) - - 3/54 (6) 1/35 (29) 179/181 (99) 16/25 (64) - -

Values are number/total number (percent). Hyphen indicate not determined in this study

ATC: anaplastic thyroid carcinoma, CLT: chronic lymphocytic thyroiditis, FA: follicular adenoma, FTC: follicular thyroid carcinoma, NH: nodular hyperplasia, PDTC: poorly differentiated thyroid carcinoma, PTC: papillary thyroid carcinoma

Table 2.
HBME-1 immunohistochemical detection in thyroid surgical specimens
Normal NH FA PTC FTC PDTC ATC
Prasad et al.33) 0/59 (0) 1/29 (3) 2/21 (10) 57/67 (85) 3/6 (50) - -
Cheung et al.2) - 0/35 (0) 0/35 (0) 76/138 (55) 2/4 (50) 4/6 (67) 1/2 (50)
Mase et al.31) - 8/62 (12) 17/62 (27) 35/36 (97.2) 33/39 (84.6) - 0/2 (0)
Choi et al.30) - - - 65/67 (97) 30/30 (100) 11/12 (91.6) 2/10 (20)
Papotti et al.32) - - 1/15 (6.6) 14/14 (100) - - -
Saggiorato et al. - - 2/50 (4) 37/39 (94.8) 17/19 (89.5) - -
Nikiforova et al.73) - - 3/23 (13) - 11/33 (34) - -
Park et al.9) - 11/54 (20.4) 17/35 (49) 166/181 (92) 22/25 (88) - -

Values are number/total number (percent). Hyphen indicate not determined in this study

ATC: anaplastic thyroid carcinoma, CLT: chronic lymphocytic thyroiditis, FA: follicular adenoma, FTC: follicular thyroid carcinoma, NH: nodular hyperplasia, PDTC: poorly differentiated thyroid carcinoma, PTC: papillary thyroid carcinoma

Table 3.
Molecular markers used in the preoperative evaluation of thyroid nodule FNA. From Rodrigues et al.8)
Average SN Average SP Average PPV Average NPV Average AC
BRAF mutations 52.35 97.92 99.85 51.62 70.54
RAS Mutations 23.00 97.20 82.20 63.20 65.00
RET rearrangements 18.20 88.72 87.00 59.60 55.30
PAX8/PPAR γ rearrangements 20.00 100.00 100.00 46.00 60.00

AC: accuracy, NPV: negative predictive value, PPV: positive predictive value, SN: sensitivity, SP: specificity

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