Journal of Cancer Research and Treatment
ISSN (Print): 2374-1996 ISSN (Online): 2374-2003 Website: http://www.sciepub.com/journal/jcrt Editor-in-chief: Jean Rommelaere
Open Access
Journal Browser
Go
Journal of Cancer Research and Treatment. 2017, 5(4), 105-112
DOI: 10.12691/jcrt-5-4-1
Open AccessArticle

The Diagnostic Utility of CD117 (c-KIT) as Adjunctive Preoperative Marker in Solitary Thyroid Nodule Management

Yomna A. Zamzam1, , Ayman M. Elsaka1 and Ayman Elnemr2

1Department of Pathology, Faculty of Medicine, Tanta University, Egypt

2Department of General Surgery, Surgical Oncology, Faculty of Medicine, Tanta University, Egypt

Pub. Date: October 20, 2017

Cite this paper:
Yomna A. Zamzam, Ayman M. Elsaka and Ayman Elnemr. The Diagnostic Utility of CD117 (c-KIT) as Adjunctive Preoperative Marker in Solitary Thyroid Nodule Management. Journal of Cancer Research and Treatment. 2017; 5(4):105-112. doi: 10.12691/jcrt-5-4-1

Abstract

Background: Unfortunately, about 30% of FNAC findings reveal an intermediate or suspicious follicular proliferation followed by thyroid surgery to establish the diagnosis. Therefore, reliable preoperative molecular markers are immensely needed to distinguish benign from malignant thyroid nodules to avoid unnecessary aggressive surgical interference in benign lesions or reoperation in malignant lesions. Aim: To investigate the utility of c-KIT marker in combination with the immunopanel of CD56, Galectin-3 and HBME-1, to distinguish between benign and malignant thyroid lesions on cell blocks in order to reduce unnecessary thyroid surgery. Patients and methods: This study was conducted on 113 patients with solitary thyroid nodule, in Pathology Department and Surgical Oncology Unit at General Surgery Department, Tanta University Hospital from June 2015 to May 2017. After histopathological examination of FNAC samples, Cell blocks were prepared for only cases diagnosed as follicular neoplasm/suspicious for follicular neoplasm for further immunohistochemistry of immunopanel including c-KIT, CD56, Galectin -3 and HBME-1, then the selected cases underwent hemithyroidectomy to establish a histological tissue diagnosis. Results: Thirty six out of 113 patients (31.8%) were diagnosed as follicular neoplasm/suspicious for follicular neoplasm on FNAC. The combined panel of CD56, Galectin-3 and HBME-1 results on cell blocks showed sensitivity 80.0%, specificity 100%, PPV 100.0%, NPV 92.86% and the accuracy was 94.44%. However after the addition of c-KIT to the immunopanel the diagnostic sensitivity, specificity, PPV, NPV and total accuracy improved to 100% for all. Conclusion: The diagnostic preoperative accuracy of the combined CD56, Galectin-3 and HBME-1 panel in solitary thyroid nodules with suspicious cytology could be extremely improved with the addition of c- as a supplementary preoperative immunostain in order to avoid over or under treatment.

Keywords:
FNAC solitary thyroid nodules c-KIT CD56 Galectin-3 HEMB-1 thyroidectomy

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Figures

Figure of 3

References:

[1]  Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007; 36: 707-35.
 
[2]  Conzo G, Avenia N, Ansaldo GL,Calo P, Palma MD, Dobrinja C. Surgical treatment of thyroid follicular neoplasms: results of a retrospective analysis of a large clinical series. Endocrine. 2017 Feb; 55(2): 530-538.
 
[3]  Dobrinja C, Trevisan G, Piscopello L, Fava M, Liguori G. Comparison between thyroidectomy and hemithyroidectomy in treatment of single thyroid nodules identified as indeterminate follicular lesions by fine-needle aspiration cytology. Ann. Ital. Chir. 2010; 81: 403-411.
 
[4]  Chiu CG, Yao R, Chan SK, Strugnell SS, Bugis S, Irvine R, Wiseman SM. Hemithyroidectomy is the preferred initial operative approach for an indeterminate fine needle aspiration biopsy diagnosis. Canadian Journal of Surgery, 2012; 55(3).
 
[5]  Baynes AL, Del Rio A, McLean C, Grodski S, Yeung MJ, Johnson WR, Serpell JW. Fine-needle aspiration of the thyroid: correlating suspicious cytology results with histological outcomes. Ann Surg Oncol. 2014 May; 21(5): 1653-8.
 
[6]  Kwon H, Kim WG, Eszlinger M, Paschke R, Song DE, Kim M. Molecular Diagnosis Using Residual Liquid-Based Cytology Materials for Patients with Nondiagnostic or Indeterminate Thyroid Nodules. Endocrinol Metab (Seoul). 2016; 31(4): 586-91.
 
[7]  Walts AE, Mirocha J, Bose S. Follicular lesion of undetermined significance in thyroid FNA revisited. Diagn Cytopathol. 2014; 42: 18-22.
 
[8]  Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009; 132(5): 658-65.
 
[9]  Hajmanoochehri F, Rabiee E. FNAC accuracy in diagnosis of thyroid neoplasms considering all diagnostic categories of the Bethesda reporting system: A single-institute experience. J Cytol. 2015; 32(4): 238-43.
 
[10]  Corso C, Gomez X, Sanabria A, Vega V, Dominguez LC, Osorio C. Total thyroidectomy versus hemithyroidectomy for patients with follicular neoplasm. A cost-utility analysis. Int J Surg. 2014; 12(8): 837-42.
 
[11]  Alexander EK, Kennedy GC, Baloch ZW, Cibas ES, Chudova D, Diggans J, Friedman L. Preoperative Diagnosis of Benign Thyroid Nodules with Indeterminate Cytology. N Engl J Med 2012; 367: 705-715.
 
[12]  Doddi S, Chohda E, Maghsoudi S, Sheehan L, Sinha A, Chandak P. The final outcome of indeterminate cytology of thyroid nodules in a District General Hospital. G Chir. 2015; 36(3): 122-7.
 
[13]  De Matos PS, Ferreira AP, de Oliveira FF, Assumpcao LV, Metze K, Ward LS. Usefulness of HBME-1, cytokeratin 19 and galectin-3 immunostaining in the diagnosis of thyroid malignancy. Histopathology. 2005; 47(4): 391-401.
 
[14]  Barut F, Onak Kandemir N, Bektas S, Bahadir B, Keser S, Ozdamar SO. Universal markers of thyroid malignancies: galectin-3, HBME-1, and cytokeratin-19. Endocr Pathol. 2010; 21(2): 80-9.
 
[15]  Nechifor-Boila A, Catana R, Loghin A, Radu TG, Borda A. Diagnostic value of HBME-1, CD56, Galectin-3 and Cytokeratin-19 in papillary thyroid carcinomas and thyroid tumors of uncertain malignant potential. Rom J Morphol Embryol. 2014; 55(1): 49-56.
 
[16]  Bizzarro T, Martini M, Marrocco C, D'Amato D, Traini E, Lombardi CP, Pontecorvi A, Fadda G, Larocca LM, Rossi ED. The Role of CD56 in Thyroid Fine Needle Aspiration Cytology: A Pilot Study Performed on Liquid Based Cytology. Schmidt RL, ed. PLoS ONE. 2015; 10(7).
 
[17]  Dunđerović, Duško, Jasmina Marković Lipkovski, Ivan Boričic, Ivan Soldatović, Vesna Božic, Dubravka Cvejić and Svetislav Tatić. “Defining the value of CD56, CK19, Galectin 3 and HBME-1 in diagnosis of follicular cell derived lesions of thyroid with systematic review of literature.” Diagn Pathol. 2015 Oct 26; 10: 196.
 
[18]  Park WY, Jeong SM, Lee JH, Kang HJ, Sin DH, Choi KU. Diagnostic value of decreased expression of CD56 protein in papillary carcinoma of the thyroid gland. Basic and Applied Pathology. 2009; 2: 63-8.
 
[19]  Mi KS, Jeong WK, Young SJ. CD56 and high molecular weight cytokeratin as diagnostic markers of papillary thyroid carcinoma. The Korean Journal of Pathology. 2011; 45(5): 477-84.
 
[20]  Barroeta JE, Baloch ZW, Lal P, Pasha TL, Zhang PJ, LiVolsi VA. Diagnostic value of differential expression of CK19, Galectin-3, HBME-1, ERK, RET, and p16 in benign and malignant follicular-derived lesions of the thyroid: an immunohistochemical tissue microarray analysis. Endocr Pathol. 2006; 17(3): 225-34.
 
[21]  Scognamiglio T, Hyjek E, Kao J, Chen YT. Diagnostic usefulness of HBME1, galectin-3, CK19, and CITED1 and evaluation of their expression in encapsulated lesions with questionable features of papillary thyroid carcinoma. Am J Clin Pathol. 2006; 126(5): 700-8.
 
[22]  Nakamura N, Erickson LA, Jin L, Kajita S, Zhang H, Qian X. Immunohistochemical separation of follicular variant of papillary thyroid carcinoma from follicular adenoma. Endocr Pathol. 2006; 17(3): 213-23.
 
[23]  Miettinen M, Lasota J. KIT (CD117): a review on expression in normal and neoplastic tissues, and mutations and their clinicopathologic correlation. Appl Immunohistochem Mol Morphol. 2005; 13: 205-220.
 
[24]  Franceschi S, Lessi F, Panebianco F, Tantillo E, La Ferla M, Menicagli M, Mazzanti CM. Loss of c-KIT expression in thyroid cancer cells. PLoS ONE. 2017; 12(3).
 
[25]  Pusztaszeri MP, Sadow PM, Faquin WC. CD117: a novel ancillary marker for papillary thyroid carcinoma in fine-needle aspiration biopsies. Cancer Cyto Pathol. 2014; 122(8): 596-603.
 
[26]  Tomei S, Mazzanti C, Marchetti I, Rossi L, Zavaglia K, Lessi F. c-KIT receptor expression is strictly associated with the biological behaviour of thyroid nodules. J Transl Med. 2012; 10: 7.