摘要目的 探讨GADD153在甲状腺滤泡样肿瘤中的表达及其鉴别诊断价值,并与CK19、Galectin-3(简称Gal-3)和HBME-1进行对比.方法 应用免疫组织化学EnVision法检测了34例甲状腺滤泡性腺瘤、46例甲状腺滤泡性癌及29例甲状腺滤泡型乳头状癌中GADD153、CK19、Gal-3和HBME-1的表达情况.结果 (1)GADD153的表达位于细胞核,在甲状腺滤泡性癌中的表达大多为中度阳性或强阳性,在滤泡性腺瘤和滤泡型乳头状癌中的表达多为阴性或弱阳性,阳性表达率分别为82.6％( 38/46)、32.4％( 11/34)、10.3％ (3/29),滤泡性癌明显高于滤泡性腺瘤和滤泡型乳头状癌,差异均有统计学意义(x2值分别为20.80和37.48；均P＜0.01).(2)CK19、Gal-3和HBME-1 三种标志物均表达于细胞质,其阳性表达率在滤泡性癌为54.3％( 25/46)、67.4％ (31/46)、58.7％( 27/46),在滤泡性腺瘤为50.0％( 17/34)、29.4％( 10/34)、32.4％( 11/34),在滤泡型乳头状癌为100％( 29/29)、93.1％ (27/29)、89.7％ (26/29),滤泡型乳头状癌与滤泡性腺瘤、滤泡性癌间比较,差异亦均有统计学意义(x2值分别为21.20和8.22;均P＜0.01).(3)根据CK19、Gal-3、HBME-1和GADD153四种标志物表达的强弱分为低表达组(记为0和1+)和高表达组(记为2+和3+),分别计算其在各组的敏感性和特异性.滤泡性腺瘤组敏感性分别为26.5％、8.8％、2.9％和11.8％,特异性为50.7％、52.0％、54.7％和58.7％；滤泡性癌组敏感性分别为19.6％、26.1％、23.9％和65.2％,特异性为41.3％、57.1％、62.0％和92.1％；滤泡型乳头状癌组敏感性分别为96.6％、82.8％、79.3％和3.4％,特异性为77.5％、81.3％、85.0％和57.5％.结论 GADD153对甲状腺滤泡性癌诊断的敏感性和特异性均较好,而CK19、Gal-3和HBME-1则能更好地提示甲状腺滤泡型乳头状癌.四者联合应用能更好地鉴别甲状腺滤泡性肿瘤.

abstractsObjective To study immunohistochemical expression of GADD153 and assess its usefulness as markers in the differential diagnoses in follicular tumors of the thyroid.Methods Immunohistochemical staining was performed on formalin-fixed paraffin-embedded tissue of 34 cases of follicular thyroid adenomas ( FTA ),46 cases of follicular thyroid carcinomas ( FTC ),29 cases of follicular variant papillary carcinomas (FVPC).Results ( 1 ) GADD153 was expressed in cell nucleus with positive or strong positive expression in FTC,and no or weak expression in FTA and FVPC.The positive expressions of GADD153 were present in 38 of 46(82.6％) in FTC,11 of 34(32.4％) in FTA and three of 29 (10.3％ ) in FVPC,the positive expression rate in FTC was obviously higher than that in FTA and in FVPC,the differences were statistically significant (x2 = 20.80 and 37.48; P ＜ 0.01 ).(2) CK19,Galectin-3(Gal-3) and HBME-1 were all expressed in the cytoplasm,the positive expressions of CK19,Gal-3 and HBME-1 were present in 54.3％ (25/46),67.4％ (31/46) and 58.7％ (27/46) in FTC; 50.0％(17/34),29.4％ (10/34) and 32.4％ (11/34) in FTA; 100％ (29/29),93.1％ (27/29) and 89.7％ (26/29) in FVPC,the differences were statistically significant as well (x2 =21.20 and 8.22; P ＜0.01 ).(3) According to the expressions of CK19,Gal-3,HBME-1 and GADD153,we divided the results into low expression group (0 or 1 + ) and high expression group ( 2 + or 3 + ),the sensitivity and the specificity were calculated.in FTA,the sensitivity were 26.5％,8.8％,2.9％ and 11.8％ ; the specificity were 50.7％,52.0％,54.7％ and 58.7％.in FTC,the sensitivity were 19.6％,26.1％,23.9％ and 65.2％ ; the specificity were 41.3％,57.1％,62.0％ and 92.1％.in FVPC,the sensitivity were 96.6％,82.8％,79.3％ and 3.4％ ; the specificity were 77.5％,81.3％,85.0％ and 57.5％.Conclusions The sensitivity and the specificity of GADD153 expression are well for diagnosing FTC,and CK19,Gal-3,HBME-1 are well for FVPC.The four markers when used in combination,are better to identify the follicular tumors of the thyroid.