Galectin-3-expression analysis in the surgical selection of follicular thyroid nodules with indeterminate fine-needle aspiration cytology: a prospective multicentre study

Autor: Rino Bellocco, Nicola Palestini, Armando Bartolazzi, Gianni Bussolati, Vincenzo Toscano, Salvatore Sciacchitano, Maria Rosa Pelizzo, Federico Arecco, Fabio Orlandi, Massimo Rugge, Pantellini F, Lucio Palombini, Caterina Mian, R. Rossetto, Marco Paolo Martegani, Ezio Ghigo, Mauro Papotti, Marco Volante, Aldo Vecchione, Giancarlo Troncone, Enrico Saggiorato, Gianmaria Pennelli, Salvatore Monti, Gennaro Chiappetta, Maria Rosaria Giovagnoli, Gerardo Botti, Angelo Carpi
Přispěvatelé: Bartolazzi, A, Orlandi, F, Saggiorato, E, Volante, M, Arecco, F, Rossetto, R, Palestini, N, Ghigo, E, Papotti, M, Bussolati, G, Martegani, M, Pantellini, F, Carpi, A, Giovagnoli, M, Monti, S, Toscano, V, Sciacchitano, S, Pennelli, G, Mian, C, Pelizzo, M, Rugge, M, Troncone, G, Palombini, L, Chiappetta, G, Botti, G, Vecchione, A, Bellocco, R, Martegani, Mp, Giovagnoli, Mr, Pennelli, Gm, Pelizzo, Mr, Troncone, Giancarlo, Palombini, Lucio, Italian Thyroid Cancer Study, G. r. o. u. p.
Rok vydání: 2008
Předmět:
Male
Pathology
Galectin 3
medicine.medical_treatment
CARCINOMA-CELLS
Cytology
Galectin-3
Prospective Studies
Thyroid Nodule
ANTIAPOPTOTIC MOLECULE
CARCINOMA-CELLS
GALECTIN-3
MANAGEMENT
DIAGNOSIS
LESIONS
EXPRESSION
NEOPLASMS
BENIGN
BIOPSY
medicine.diagnostic_test
Thyroid
follicular thyroid nodule
Middle Aged
Immunohistochemistry
medicine.anatomical_structure
Italy
Oncology
Predictive value of tests
BIOPSY
Thyroidectomy
Female
Radiology
medicine.symptom
NEOPLASMS
EXPRESSION
Adult
Thyroid nodules
medicine.medical_specialty
BENIGN
Biopsy
Fine-Needle
ANTIAPOPTOTIC MOLECULE
Unnecessary Procedures
Dignostic Test
Cancer
Accuracy
DIAGNOSIS
Sensitivity and Specificity
Thyroid carcinoma
Predictive Value of Tests
Biopsy
MANAGEMENT
medicine
Humans
Thyroid Neoplasms
fine-needle aspiration cytology
MED/01 - STATISTICA MEDICA
Aged
LESIONS
business.industry
Patient Selection
Reproducibility of Results
Nodule (medicine)
medicine.disease
business
Popis: Background: In the USA, about 30 200 well-differentiated thyroid carcinomas were diagnosed in 2007, but the prevalence of thyroid nodules is much higher (about 5% of the adult population). Unfortunately, the preoperative characterisation of follicular thyroid nodules is still a challenge, and many benign lesions, which remain indeterminate after fine-needle aspiration (FNA) cytology are referred to surgery. About 85% of these thyroid nodules are classified as benign at final histology. We aimed to assess the diagnostic effect of galectin-3 expression analysis in distinguishing preoperatively benign from malignant follicular thyroid nodules when FNA findings were indeterminate. Methods: 544 patients were enrolled between June 1, 2003, and Aug 30, 2006. We used a purified monoclonal antibody to galectin-3, a biotin-free immunocytohistochemical assay, and a morphological and phenotypic analysis of FNA-derived cell-block preparations. Galectin-3-expression analysis was applied preoperatively on 465 follicular thyroid proliferations that were candidates for surgery, and its diagnostic accuracy was compared with the final histology. Findings: 31 patients were excluded because they had small galectin-3-negative thyroid nodules; we did not have data for 47 patients; and one patient with an oncocytic nodule was excluded. 331 (71%) of the assessable 465 preoperative thyroid FNA samples did not express galectin-3. 280 (85%) of these galectin-3-negative lesions were classified as benign at final histology. Galectin-3 expression was detected, instead, in 134 of 465 (29%) thyroid proliferations, 101 (75%) of which were confirmed as malignant. The overall sensitivity of the galectin-3 test was 78% (95% CI 74-82) and specificity was 93% (90-95). Estimated positive predictive value was 82% (79-86) and negative predictive value was 91% (88-93). 381 (88%) of 432 patients with follicular thyroid nodules who were referred for thyroidectomy were correctly classified preoperatively by use of the galectin-3 test. However, 29 (22%) of 130 cancers were missed by the galectin-3 method. Interpretation: Our findings show that if the option of surgery was based theoretically on galectin-3 expression alone, only 134 thyroid operations would have been done in 465 patients; therefore a large proportion (71%) of unnecessary thyroid surgical procedures could be avoided, although a number of galectin-3-negative cancers could be potentially missed. The galectin-3 test proposed here does not replace conventional FNA cytology, but represents a complementary diagnostic method for those follicular nodules that remain indeterminate. Funding: Compagnia di San Paolo, Turin, Italy, and Italian Association for Cancer Research (AIRC), Rome, Italy. © 2008 Elsevier Ltd. All rights reserved.
Databáze: OpenAIRE
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