High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma.

Autor: Mu N; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. Ninni.Mu@ki.se.; Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden. Ninni.Mu@ki.se.; Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden. Ninni.Mu@ki.se., Juhlin CC; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.; Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden.; Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden., Tani E; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.; Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden., Sofiadis A; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.; Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden.; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden., Reihnér E; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden., Zedenius J; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.; Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden., Larsson C; Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.; Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden.; Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden., Nilsson IL; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.; Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden.
Jazyk: angličtina
Zdroj: Endocrine [Endocrine] 2018 Aug; Vol. 61 (2), pp. 293-302. Date of Electronic Publication: 2018 May 23.
DOI: 10.1007/s12020-018-1627-z
Abstrakt: Purpose: Preoperative distinction of follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) is a diagnostic challenge. Our aim was to investigate whether the Ki-67 proliferation index in fine needle aspiration material can contribute to the diagnosis of FTC.
Methods: We analyzed retrospectively cytological Ki-67 index determined in routine clinical setting and clinical data for 61 patients with FTC, 158 patients with FTA and 15 patients with follicular tumor of uncertain malignant potential (FT-UMP) surgically treated and diagnosed by histopathology at Karolinska University Hospital 2006-2017 (Cohort A). A previously published cohort of 109 patients with follicular tumors was re-analyzed as well (Cohort B).
Results: In Cohort A, patients with FTC had a higher Ki-67 index (p < 0.001), larger tumor size (p < 0.001) and higher age at diagnosis (p = 0.036) compared to patients with FTA or FT-UMP. Hürthle cell differentiation, present in 50 FTA, 20 FTC and 8 FT-UMP, was associated with higher Ki-67 index (p = 0.009). Multivariate analysis of Cohort A identified a high Ki-67 index (odds ratio [OR]: 1.215, p < 0.001) and large tumor size (OR: 1.038, p < 0.001) as independent predictors of FTC. Results remained consistent after exclusion of Hürthle cell tumors and in pooled analysis of Cohort A + B. The area under curve of the Ki-67 index for predicting FTC was 0.722 and a cut-off for Ki-67 index at above 5% resulted in a specificity at 93% and sensitivity at 31%. Subgroup analysis of FTCs in Cohort A showed an association of higher Ki-67 index to extrathyroidal extension (p = 0.001) as well as widely invasive subtype (p = 0.019) based on the WHO 2017 classification.
Conclusions: Pre-operative Ki-67 index may add diagnostic information for a subset of patients with follicular thyroid tumors.
Databáze: MEDLINE
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