巨噬细胞在甲状腺细针穿刺细胞学诊断中的意义

doi:10.16150/j.1671-2870.2018.01.010

摘要/Abstract

摘要： 目的：回顾性分析甲状腺乳头状癌（papillary thyroid carcinoma,PTC）患者的细针穿刺细胞学检查（fine needle aspirate cytology,FNAC）涂片中巨噬细胞数量与肿瘤转移间的关系,探讨巨噬细胞在PTC进展中的变化及其对临床诊断的价值。方法：调取1 392例甲状腺结节患者的术前FNAC涂片（不包含亚急性甲状腺炎病例）,由2位细胞病理医师重新阅片,回顾性分析PTC患者FNAC涂片中巨噬细胞的数量及其对临床诊断的价值。结果：1 392例甲状腺结节患者中,经术后病理检查证实为甲状腺良性结节患者共139例,证实为PTC患者1 253例。找到巨噬细胞即定义为阳性,PTC组的巨噬细胞阳性率为58.6%,显著高于良性甲状腺结节组（2.2%）（P<0.05）。1 253例PTC患者中有748例未发生肿瘤转移,505例发生颈部淋巴结转移,而PTC未转移组和转移组的巨噬细胞阳性率分别为55.2%和63.6%,PTC转移组的巨噬细胞阳性率显著高于未转移组（P<0.05）。将PTC患者按100个低倍镜下巨噬细胞数量由少到多划分为6个等级,巨噬细胞数量0级到Ⅴ级患者发生颈部淋巴结转移的概率分别为35.5%、41.6%、40.3%、47.8%、54.5%、56.5%,巨噬细胞数量Ⅱ级以下各组与Ⅱ级以上各组间进行两两组间比较,颈部淋巴结转移率差异均有统计学意义（P均<0.05）,巨噬细胞数量0级组与Ⅴ级组比较,患者发生颈部淋巴结转移的概率由从35.5%升高到56.5%。结论：在FNAC检查中,观察巨噬细胞计数有助于PTC的诊断,其数量的多少在一定程度上可反映PTC的颈部淋巴结转移率。

关键词: 甲状腺乳头状癌, 巨噬细胞, 肿瘤相关巨噬细胞, 淋巴结甲状腺乳头状癌转移

Abstract: Objective: To analyze the correlation between macrophage count in fine needle aspirate cytology (FNAC） smear and tumor metastasis in papillary thyroid cancer(PTC) and to explore the value of macrophage count in the diagnosis and the progression of PTC. Methods: A total of 1 392 patients with thyroid nodules (excluding subacute thyroiditis) were enrolled in this study. Number of macrophage was counted in FNAC smear of thyroid nodules, and its clinical value for diagnosing PTC was evaluated. Results: Among these patients, 1 253 cases were confirmed as PTC and 139 cases as benign lesion by pathological examination. The positive rates of macrophages in benign and PTC groups were 2.2% and 58.6%, respectively, and was significantly higher in PTC group than in benign group (P<0.05). Of the 1 253 malignant cases, 505 cases had cervical lymph node metastasis and the other had no metastasis. It was denfinted as positive presence when macrophage was found in smears. The positive rates of macrophages in non-metastasis group and metastasis group were 55.2% and 63.6% (P<0.05). When the 1 253 malignant cases were divided into 6 levels by the macrophage count: grade 0 to grade V, the rates of cervical lymph node metastasis in these six grades were 35.5%, 41.6%, 40.3%, 47.8%, 54.5% and 56.5%, respectively, increased with the increase of macrophage count. Conclusions: For thyroid fine needle aspiration cytology examination, the macrophage count may help the diagnosis PTC, and the number of macrophage may reflect the rate of cervical lymph node metastasis of PTC.

Key words: Papillary thyroid carcinoma, macrophages, Tumor-associated macrophages, Lymph node metastasis

中图分类号:

R736.1

毛敏静, 张斌斌, 叶廷军, 王学锋. 巨噬细胞在甲状腺细针穿刺细胞学诊断中的意义[J]. 诊断学理论与实践, 2018, 17(01): 56-59.

MAO Minjing, ZHANG Binbin, YE Tingjun, WANG Xuefeng. Significance of macrophage count in fine needle aspirate cytology smear from papillary thyroid carcinoma[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(01): 56-59.

参考文献

[1] Jung KY, Cho SW, Kim YA, et al.Cancers with Higher Density of Tumor-Associated Macrophages Were Associa-ted with Poor Survival Rates[J]. J Pathol Transl Med,2015,49(4):318-324.
[2] 秦鑫, 张萍, 张毓飞, 等. 肿瘤相关巨噬细胞的研究进展[J]. 细胞与分子免疫学杂志,2015,31(7):1004-1007.
[3] Raggi C, Mousa HS, Correnti M, et al.Cancer stem cells and tumor-associated macrophages: a roadmap for multitargeting strategies[J]. Oncogene,2016,35(6):671-682.
[4] Yuri P, Hendri AZ, Danarto R.Association between tumor-associated macrophages and microvessel density on prostate cancer progression[J]. Prostate Int,2015,3(3):93-98.
[5] Kang FB, Wang L, Li D, et al.Hepatocellular carcinomas promote tumor-associated macrophage M2-polarization via increased B7-H3 expression[J]. Oncol Rep,2015,33(1):274-282.
[6] Ke X, Wu M, Lou J, et al.Activation of Toll-like receptors signaling in non-small cell lung cancer cell line induced by tumor-associated macrophages[J]. Chin J Cancer Res,2015,27(2):181-189.
[7] Lin CN, Wang CJ, Chao YJ, et al.The significance of the co-existence of osteopontin and tumor-associated macrophages in gastric cancer progression[J]. BMC Cancer,2015,15:128.
[8] Yang J, Li X, Liu X, et al.The role of tumor-associated macrophages in breast carcinoma invasion and metastasis[J]. Int J Clin Exp Pathol,2015,8(6):6656-6664.
[9] Fang W, Ye L, Shen L, et al.Tumor-associated macrophages promote the metastatic potential of thyroid papillary cancer by releasing CXCL8[J]. Carcinogenesis,2014,35(8):1780-1787.
[10] Kim S, Cho SW, Min HS, et al.The expression of tumor-associated macrophages in papillary thyroid carcinoma[J]. Endocrinol Metab (Seoul),2013,28(3):192-198.
[11] 周宪宾, 姚成芳. 巨噬细胞M1/M2 极化分型的研究进展[J]. 中国免疫学杂志,2012,28(10):957-960.

[1]	王文涵, 夏蜀珺, 詹维伟. 长链非编码RNA ENST00000489676在超声评估甲状腺乳头状癌颈部淋巴结转移中的应用[J]. 诊断学理论与实践, 2022, 21(04): 514-519.
[2]	徐琛莹, 李嫣然, 倪晓枫, 徐上妍, 林青. 超声预测老年甲状腺乳头状癌患者颈部淋巴结转移的效能及相关超声征象分析[J]. 诊断学理论与实践, 2022, 21(03): 343-348.
[3]	况李君, 陶玲玲, 詹维伟, 李伟伟, 樊金芳, 周伟. 负压细针抽吸和毛细抽吸活检法穿刺洗脱液中甲状腺球蛋白测定在甲状腺乳头状癌淋巴结转移中的诊断价值比较[J]. 诊断学理论与实践, 2021, 20(04): 367-371.
[4]	周艺, 杨莉. 粒细胞-巨噬细胞集落刺激因子在肿瘤免疫治疗中的作用机制及临床应用进展[J]. 诊断学理论与实践, 2021, 20(04): 407-413.
[5]	杨一娴, 倪仲馨, 夏蜀珺, 周伟, 詹维伟. 多灶性与单灶性甲状腺乳头状癌的临床病理特征及超声表现的比较[J]. 诊断学理论与实践, 2021, 20(02): 168-172.
[6]	安晓宁, 魏兆楠, 沈艳, 史浩, 张文, 陈永熙. 耗竭巨噬细胞抑制脂多糖诱导小鼠肾脏及全身炎症损伤的作用研究[J]. 诊断学理论与实践, 2021, 20(02): 195-200.
[7]	王星, 汪蓉晖, 张桂萍, 董屹婕, 周伟, 詹维伟. 10 388个甲状腺结节行超声引导下细针抽吸活检的甲状腺癌各亚型诊断准确率的10年研究[J]. 诊断学理论与实践, 2020, 19(04): 359-363.
[8]	杜月月, 杜军, 沈倩, 葛绾宇, 吴海波. Warthin瘤样甲状腺乳头状癌1例及临床病理观察[J]. 诊断学理论与实践, 2020, 19(02): 188-190.
[9]	杨志芳, 方国平, 詹维伟, 吉日. 去分化实体型甲状腺乳头状癌伴黏膜相关淋巴组织结外边缘区淋巴瘤1例病理特征并文献分析[J]. 诊断学理论与实践, 2019, 18(05): 548-554.
[10]	余小情, 詹维伟, 周伟, 吴宇, 王怡, 李伟伟, 陶玲玲, 樊金芳. 甲状腺乳头状癌与淋巴结密度相关的临床及超声特征分析[J]. 诊断学理论与实践, 2019, 18(05): 555-559.
[11]	蔡蓉, 闵学文, 陈美蓉, 沈娅婷, 石群立, 周晓蝶. BRAF V600E（VE1）在甲状腺乳头状癌中的表达及其临床意义[J]. 诊断学理论与实践, 2018, 17(05): 552-556.
[12]	宋丹丹, 常春康, 郭娟, 许峰, 赵佑山, 吴凌云. 骨髓增生异常综合征患者骨髓巨噬细胞百分比异常及其意义[J]. 诊断学理论与实践, 2018, 17(04): 439-443.
[13]	王唯一, 章永平, 袁耀宗, 吴云林, 陈平. 活化STAT蛋白抑制剂1调控巨噬细胞迁移能力及机制的实验研究[J]. 诊断学理论与实践, 2017, 16(01): 60-65.
[14]	裴小娟, 薛秀芬, 朱影玲, 刘少杰,. 甲状腺癌中p-Akt、c-Myc、E-cad及VEGF的表达及其临床病理意义[J]. 诊断学理论与实践, 2016, 15(03): 302-307.
[15]	时敏, 周伟, 仇纯武, 詹维伟,. 桥本甲状腺炎背景下甲状腺微小乳头状癌的超声表现探讨[J]. 诊断学理论与实践, 2016, 15(02): 165-168.