Опухоли головы и шеи. 2023; 13: 10-23
Проблемы диагностики фолликулярного рака щитовидной железы
https://doi.org/10.17650/2222-1468-2023-13-3-10-23Аннотация
Введение. фолликулярный рак щитовидной железы встречается значительно реже папиллярного. тем не менее основные трудности в дооперационной диагностике связаны именно с этим морфологическим типом. тонкоигольная аспирационная биопсия неспособна отличить доброкачественную фолликулярную аденому от фолликулярной карциномы, что вынуждает хирургов выполнять диагностическую резекцию щитовидной железы у всех пациентов с цитологическим заключением «фолликулярная опухоль».
Цель исследования – поиск специфических для фолликулярного рака микроРНК с помощью секвенирования нового поколения.
Материалы и методы. проанализированы данные пациентов с дооперационным цитологическим заключением
«фолликулярная опухоль», прооперированных в челябинском центре эндокринной хирургии с 2021 по 2022 г. гистологические препараты дважды пересматривались экспертами-патологами. секвенирование генома выполнено в 8 гистологических образцах фолликулярного рака и 8 образцах фолликулярной аденомы. уровни экспрессии отобранных микроРНК сравнивали со 198 архивными цитологическими образцами различных типов опухолей щитовидной железы.
Результаты. Риск злокачественности при цитологическом заключении «фолликулярная опухоль» составил 25,4 % (ошибка 74,6 %). фолликулярный рак был впервые установлен у 36 пациентов, заболеваемость составила 0,68 случая на 100 тыс. населения в год. Диагноз «фолликулярный рак» подтвержден 3 морфологами в 8 (36,4 %) случаях. секвенирование позволило выявить 5 наиболее различающихся между фолликулярным раком и фолликулярной аденомой микроРНК: miR-625, miR-323a, let-7a, let-7c и miR-574. уровень ошибок при дифференцировке фолликулярной аденомы и фолликулярного рака с помощью выбранных нами микроРНК составил 21 % (при кросс-валидации 35 %).
Заключение. молекулярно-генетическое исследование на дооперационном этапе, направленное на дифференцировку фолликулярного рака и фолликулярной аденомы, по сравнению с цитологическим исследованием имеет большую, но недостаточную для принятия окончательного клинического решения точность.
Список литературы
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39. Rosai J., Kuhn E., Carcangiu M.L. Pitfalls in thyroid tumour pathology. Histopathology 2006;49:107–20. DOI: 10.1111/j.1365-2559.2006.02451.x
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Head and Neck Tumors (HNT). 2023; 13: 10-23
Problems of follicular thyroid carcinoma diagnostics
https://doi.org/10.17650/2222-1468-2023-13-3-10-23Abstract
Introduction. Follicular thyroid cancer is much less common than papillary cancer. Nevertheless, the main difficulties in preoperative diagnosis are associated with this morphological type. A fine needle aspiration biopsy is not able to distinguish a benign follicular adenoma from a follicular carcinoma, which forces surgeons to perform diagnostic resection of the thyroid gland in all patients with a cytological conclusion «follicular tumor».
Aim. To search for microRNAs specific to follicular cancer by sequencing a new generation.
Materials and methods. The data of patients with a preoperative cytological conclusion «follicular tumor» operated at the Chelyabinsk Center for Endocrine Surgery from 2021 to 2022 were analyzed. Histological preparations were reviewed twice by pathologists. Genome sequencing was performed in 8 histological samples of follicular cancer and 8 samples of follicular adenoma. The expression levels of the selected microRNAs were compared with 198 archived cytological samples of various types of thyroid tumors.
Results. The risk of malignancy at the cytological conclusion «follicular tumor» was 25.4 % (error 74.6 %). Follicular cancer was first detected in 36 patients, the incidence was 0.68 new cases per 100 thousand population per year. The diagnosis of «follicular cancer» was confirmed by 3 morphologists in 8 (36.4 %) cases. Sequencing revealed the 5 most distinct microRNAs between follicular cancer and follicular adenoma: miR-625, miR-323a, let-7a, let-7c and miR-574. The level of errors in the differentiation of follicular adenoma and follicular cancer using the microRNAs we selected was 21 % (35 % with cross-validation).
Conclusion. Molecular genetic research at the preoperative stage, aimed at differentiating follicular cancer and follicular adenoma, in comparison with cytological research has a greater, but insufficient accuracy for making a final clinical decision.
References
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2. Cibas E.S., Ali S.Z. The 2017 Bethesda System for reporting thyroid cytopathology. Thyroid 2017;27(11):1341–6. DOI: 10.1089/thy.2017.0500
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31. Bylesjö M., Rantalainen M., Cloarec O. et al. OPLS discriminant analysis: combining the strengths of PLS-DA and SIMCA classification. J Chemometrics 2006;20(8–10):341–51. DOI: 10.1002/cem.1006
32. Thevenot E., Roux A., Xu Y. et al. Analysis of the human adult urinary metabolome variations with age, body mass index, and gender by implementing a comprehensive workflow for univariate and OPLS statistical analyses. J Proteome Res 2015;14(8):3322–35. DOI: 10.1021/acs.jproteome.5b00354
33. Tenenhaus M. La raegression PLS. Paris, Editions Technip, 1998.
34. Ricco R. TANAGRA: a free software for research and academic purposes. Proceedings of EGC’2005, RNTI-E-3. (In French). Available at: https://www.researchgate.net/publication/220786300_TANAGRA_un_logiciel_gratuit_pour_l'enseignement_et_la_recherche.
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38. Valderrabano P., Leon M.E., Centeno B.A. et al. Institutional prevalence of malignancy of indeterminate thyroid cytology is necessary but insufficient to accurately interpret molecular marker tests. Eur J Endocrinol 2016;174(5):621–9. DOI: 10.1530/EJE-15-1163
39. Rosai J., Kuhn E., Carcangiu M.L. Pitfalls in thyroid tumour pathology. Histopathology 2006;49:107–20. DOI: 10.1111/j.1365-2559.2006.02451.x
40. Franc B., de la Salmonière P., Lange F. et al. Interobserver and intraobserver reproducibility in the histopathology of follicular thyroid carcinoma. Hum Pathol 2003;34(11):1092–100. DOI: 10.1016/s0046-8177(03)00403-9
41. Cipriani N.A., Nagar S., Kaplan S.P. et al. Follicular thyroid carcinoma: how have histologic diagnoses changed in the last halfcentury and what are the prognostic implications? Thyroid 2015;25(11):1209–16. DOI: 10.1089/thy.2015.0297
