目的：分析BRAF V600E、CK19及Galectin-3抗体在甲状腺乳头状癌（papillary thyroid carcinoma, PTC）中的表达情况,并结合PTC的临床病理特征,探讨BRAF V600E抗体的诊断价值。方法：对80例PTC患者的临床病理资料进行分析,并以31例结节性甲状腺肿、13例桥本甲状腺炎患者作为对照组,观察BRAF V600E、CK19、Galectin-3 3种抗体在PTC组与对照组间的表达差异,并分析BRAF V600E抗体与PTC临床病理特征间的相关性。结果：PTC患者甲状腺被膜侵犯情况与淋巴结转移率有关（P<0.05）。80例PTC患者病理组织中的BRAF V600E、CK19及Galectin-3抗体阳性率分别为62.50%、98.75%、95.00%,联合运用CK19及Galectin-3,其诊断灵敏度达95.00%;BRAF V600抗体的诊断特异度为100%,分别与CK19、Galectin-3联合运用,可提高诊断特异度。BRAF V600E抗体表达与PTC患者的年龄、性别、肿瘤直径、甲状腺被膜侵犯与否、淋巴结转移、组织学亚型等临床病理参数间均无统计学相关性（P>0.05）。结论：联合运用BRAF V600E、CK19、Galectin-3抗体有助于PTC的病理诊断,BRAF V600E抗体可起到对BRAF V600E基因突变的初筛作用。
Objective: To investigate the expressions of BRAF V600E, CK19 and galectin-3 antibodies in papillary thyroid carcinoma, and study the diagnostic value of BRAF V600E antibody when in corporating with the clinicopathological characteristics of PTC. Methods: The clinicopathological data of 80 patients with PTC were analyzed; 31 cases of nodular goiter and 13 cases with Hashimoto thyroiditis were served as controls. BRAF V600E, CK19 and galectin-3 antibodies in PTC and control group were detecteds and the correlation between BRAF V600E antibody and clinicopathological characteristics of PTC was analyzed. Results: Correlation between thyroid membrane invasion and lymph node metastasis was observed in PTC patients(P<0.05). The positive rates of BRAF V600E, CK19 and galectin-3 antibodies in patients with PTC were 62.50%, 98.75%, 95.00%, respectively. The sensitivity of CK19 combined with galectin-3antibodies was 95.00%, and the specificity of BRAF V600 antibody was 100%. The specificity of CK19 and galection-3 antibodies could be improved by combining with BRAF V600 antibody. There was no statistical correlation between expression of BRAF V600E antibody and age, gender, lesion size, thyroid membrane invasion, lymph node metastasis, histological subtype of PTC (P>0.05). Conclusions: The combined detection of BRAF V600E, CK19 and Galectin-3 antibodies is helpful for the pathological diagnosis of PTC.Meanwhile, BRAF V600E antibody plays a preliminary screening role for the mutation of BRAF V600E gene.
[1] Jemal A, Bray F, Center MM, et al.Global cancer statistics[J]. CA Cancer J Clin,2011,61(2):69-90.
[2] Tuttle RM, Ball DW, Byrd D, et al.Thyroid carcinoma[J]. J Natl Compr Canc Netw,2010,8(11):1228-1274.
[3] Kim SK, Song KH, Lim SD, et al.Clinical and pathological features and the BRAF(V600E) mutation in patients with papillary thyroid carcinoma with and without concurrent Hashimoto thyroiditis[J]. Thyroid,2009,19(2):137-141.
[4] 滕晓东, 王丽君, 姚洪田, 等. 细胞角蛋白19、galectin-3、HBME-1在甲状腺病变上的表达及鉴别诊断意义[J]. 中华病理学杂志,2004,33(3):212-216.
[5] 陈云新, 沈丹华, 孙昆昆, 等. 甲状腺微小乳头状癌中Galectin-3、CK19、HBME-1和CD56的表达及意义[J]. 临床与实验病理学杂志,2010,26(4):425-428.
[6] 佟杰, 王岩, 笪冀平. CK19HBME-1Galectin-3等表达在甲状腺乳头状微小癌与良性病变鉴别诊断中的意义[J]. 中华肿瘤杂志,2011,33(8):599-604.
[7] 郑璐滢, 朱建善, 王家东, 等. Galectin-3、CK19和TPO表达在甲状腺良恶性肿瘤病理诊断中的价值[J]. 临床与实验病理学杂志,2005,20(4):449-452.
[8] 邓敏, 叶顾萍, 马建中, 等. 甲状腺乳头状癌中CK19、Galectin-3、HBME-1和TPO的表达及意义[J]. 临床与实验病理学杂志,2011,27(8):843-846.
[9] 白杨, 孙璐, 郭爱桃, 等. CK19、galectin-3和syndecan-1在甲状腺乳头状病变鉴别诊断中的意义[J]. 诊断病理学杂志,2013,20(12):771-774.
[10] 怀建国, 蒋艳, 杨小苗, 等. 免疫组化联合检测在甲状腺乳头状病变诊断中的意义[J]. 诊断病理学杂志,2015,22(7):433-435.
[11] Kim TY, Kim WB, Rhee YS, et al.The BRAF mutation is useful for prediction of clinical recurrence in low-risk patients with conventional papillary thyroid carcinoma[J]. Clin Endocrinol (Oxf),2006,65(3):364-368.
[12] Yip L, Nikiforova MN, Carty SE, et al.Optimizing surgical treatment of papillary thyroid carcinoma associated with BRAF mutation[J]. Surgery,2009,146(6):1215-1223.
[13] Xing M, Alzahrani AS, Carson KA, et al.Association between BRAF V600E mutation and recurrence of papillary thyroid cancer[J]. J Clin Oncol,2015,33(1):42-50.
[14] Prescott JD, Sadow PM, Hodin RA, et al.BRAF V600E status adds incremental value to current risk classification systems in predicting papillary thyroid carcinoma recurrence[J]. Surgery,2012,152(6):984-990.
[15] Abd Elmageed ZY, Sholl AB, Tsumagari K, et al.Immunohistochemistry as an accurate tool for evaluating BRAF-V600E mutation in 130 samples of papillary thyroid cancer[J]. Surgery,2017,161(4):1122-1128.
[16] 陈公仆, 王圣应, 郑绪才. 超声引导下细针穿刺细胞学检查对鉴别甲状腺良恶性肿瘤的价值[J]. 安徽医学,2017,38(12):1570-1571.
