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。
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.
[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.
