Прогнозирование течения высокодифференцированного рака щитовидной железы на основании дооперационного определения уровня экспрессии натрий-йодного симпортера

Abstract

Nowadays it is of utmost importance to forecast a cancer progression, in particular, thyroid cancer in order to make a decision about the optimal treatment tactics. Aim. To evaluate the possibility of preoperative detection of membrane located NIS expression level by flow cytofluorometry (FC) method in fine needle aspiration biopsy (FNAB) material as a marker of unfavourable prognosis of DTC. Materials and methods. The research was of prospective character. 43 patients with DTC who underwent medical treatment in general surgery department of St.Petersburg State Medical University named after Pavlov in the period 2009–2010 were enrolled in the study. Level of NIS expression in FNAB material analysed preoperatively and expression was accessed quantitavely by FC method. According to the results of routine histology examination: 28 patients needed radioiodine ablation (RIA). During 48 months of observation recurrences were detected in 10 cases. All recurrences were of local character. Not a single patient from the group without RIA had recurrence. Results. FC method of NIS detection in FNAB material is technically possible and the results obtained are in line with immunohistochemical method. When studying the level of membrane located NIS expression in DTC it was found that the mean level in the group without RIA and disease recurrence is 6.5% with maximum up to 11.6 %. The lowest mean level of NIS expression was in patients group with recurrence of DTC after RIA ( p = 0.00083). We proved that crutial for recurrence of DTC after RIA were decreased level of membrane located NIS expression less than 1%. That means that when NIS level is detected to be less than 1% a patient can be considered to belong to a high-risk group and more aggressive surgical tactics must be used to decrease the risk of recurrence. Conclusion. It is possible to use FC method of detecting NIS expression level on preoperative stage in FNAB material. If it is detected that NIS expression level is lower than 1%, these patients belong to high-risk group and for this group thyroidectomy and central compartment lymph node dissection are recommended.