Abstract
BackgroundTo distinguish between malignant and benign lesions of the thyroid gland histological demonstration is often required since the fine-needle aspiration biopsy method applied pre-operatively has some limitations. In an attempt to improve diagnostic accuracy, markers using immunocytochemistry and immunohistochemistry techniques have been studied, mainly cytokeratin-19 (CK-19), galectin-3 (Gal-3) and Hector Battifora mesothelial-1 (HBME-1). However, current results remain controversial. The aim of the present article was to establish the diagnostic accuracy of CK-19, Gal-3 and HBME-1 markers, as well as their associations, in the differentiation of malignant and benign thyroid lesions.MethodsA systematic review of published articles on MEDLINE and The Cochrane Library was performed. After establishing inclusion and exclusion criteria, 66 articles were selected. The technique of meta-analysis of diagnostic accuracy was employed and global values of sensitivity, specificity, area under the summary ROC curve, and diagnostic odds ratio (dOR) were calculated.ResultsFor the immunohistochemistry technique, the positivity of CK-19 for the diagnosis of malignant thyroid lesions demonstrated global sensitivity of 81% and specificity of 73%; for Gal-3, sensitivity of 82% and specificity of 81%; and for HBME-1, sensitivity of 77% and specificity of 83%. The association of the three markers determined sensitivity of 85%, specificity of 97%, and diagnostic odds ratio of 95.1. Similar results were also found for the immunocytochemistry assay.ConclusionThis meta-analysis demonstrated that the three immunomarkers studied are accurate in pre- and postoperative diagnosis of benign and malignant thyroid lesions. Nevertheless, the search for other molecular markers must continue in order to enhance this diagnostic accuracy since the results found still show a persistency of false-negative and false-positive tests.Virtual slidesHttp://www.diagnosticpathology.diagnomx.eu/vs/3436263067345159
Highlights
Thyroid gland carcinoma is a very prevalent neoplasia worldwide
A survey sponsored by the World Health Organization (WHO) in 2010 revealed that there are around 44,670 new cases and 1,690 deaths caused by this disease every year [1]
The majority of malignant lesions of the thyroid, such as papillary carcinoma, medullary carcinoma and undifferentiated histological types, can be diagnosed by cytological criteria using samples obtained by fine-needle aspiration biopsy (FNAB) guided by ultrasonography [2]
Summary
Thyroid gland carcinoma is a very prevalent neoplasia worldwide. A survey sponsored by the World Health Organization (WHO) in 2010 revealed that there are around 44,670 new cases and 1,690 deaths caused by this disease every year [1].The majority of malignant lesions of the thyroid, such as papillary carcinoma, medullary carcinoma and undifferentiated histological types, can be diagnosed by cytological criteria using samples obtained by fine-needle aspiration biopsy (FNAB) guided by ultrasonography [2]. To distinguish between malignant and benign lesions histological demonstration is often required for a precise diagnosis. They are cytologically grouped as undetermined tumors or suspected follicular neoplasia [4,5,6,7] and patients often undergo a diagnostic surgical procedure (thyroidectomy) even though the general carcinoma rate of this condition is very low [8]. To distinguish between malignant and benign lesions of the thyroid gland histological demonstration is often required since the fine-needle aspiration biopsy method applied pre-operatively has some limitations. The aim of the present article was to establish the diagnostic accuracy of CK-19, Gal-3 and HBME-1 markers, as well as their associations, in the differentiation of malignant and benign thyroid lesions
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