J Pathol Transl Med.  2018 Nov;52(6):404-410. 10.4132/jptm.2018.09.20.

The Usefulness of Immunocytochemistry of CD56 in Determining Malignancy from Indeterminate Thyroid Fine-Needle Aspiration Cytology

Affiliations
  • 1Department of Pathology, Gangnam Severance Hospital, Seoul, Korea. SOONWONH@yuhs.ac

Abstract

BACKGROUND
Fine-needle aspiration cytology serves as a safe, economical tool in evaluating thyroid nodules. However, about 30% of the samples are categorized as indeterminate. Hence, many immunocytochemistry markers have been studied, but there has not been a single outstanding marker. We studied the efficacy of CD56 with human bone marrow endothelial cell marker-1 (HBME-1) in diagnosis in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) category III.
METHODS
We reviewed ThinPrep liquid-based cytology (LBC) samples with Papanicolaou stain from July 1 to December 31, 2016 (2,195 cases) and selected TBSRTC category III cases (n = 363). Twenty-six cases were histologically confirmed as benign (six cases, 23%) or malignant (20 cases, 77%); we stained 26 LBC slides with HBME-1 and CD56 through the cell transfer method. For evaluation of reactivity of immunocytochemistry, we chose atypical follicular cell clusters.
RESULTS
CD56 was not reactive in 18 of 20 cases (90%) of malignant nodules and showed cytoplasmic positivity in five of six cases (83%) of benign nodules. CD56 showed high sensitivity (90.0%) and relatively low specificity (83.3%) in detecting malignancy (p = .004). HBME-1 was reactive in 17 of 20 cases (85%) of malignant nodules and was not reactive in five of six cases (83%) of benign nodules. HBME-1 showed slightly lower sensitivity (85.0%) than CD56. The specificity in detecting malignancy by HBME-1 was similar to that of CD56 (83.3%, p = .008). CD56 and HBME-1 tests combined showed lower sensitivity (75.0% vs 90%) and higher specificity (93.8% vs 83.3%) in detecting malignancy compared to using CD56 alone.
CONCLUSIONS
Using CD56 alone showed relatively low specificity despite high sensitivity for detecting malignancy. Combining CD56 with HBME-1 could increase the specificity. Thus, we suggest that CD56 could be a useful preoperative marker for differential diagnosis of TBSRTC category III samples.

Keyword

Biopsy, fine-needle; Thyroid fine-needle aspiration; Immunohistochemical staining; CD56; HBME-1

MeSH Terms

Biopsy, Fine-Needle*
Bone Marrow
Cytoplasm
Diagnosis
Diagnosis, Differential
Endothelial Cells
Humans
Immunohistochemistry*
Methods
Sensitivity and Specificity
Thyroid Gland*
Thyroid Nodule

Figure

  • Fig. 1. Flow diagram of the study population. FNAC, fine-needle aspiration cytology; ICC, immunocytochemistry.

  • Fig. 2. A thyroid lesion diagnosed as category III on liquid-based cytology (Papanicolaou, ×400).

  • Fig. 3. (A) CD56 negativity in the case in Fig. 1 (avidin-biotin-peroxidase complex, ×400). (B) Negative CD56 expression on the histochemical sample for the same case (avidin-biotin-peroxidase complex, ×400).

  • Fig. 4. (A) Cytoplasm-membranous CD56 positivity in a thyroid lesion diagnosed as category III on liquid-based cytology but diagnosed as benign goiter on the histological sample (avidin-biotin-peroxidase complex, ×400). (B) Diffuse cytoplasmic and membranous CD56 positivity on the histological sample for the same case (avidin-biotin-peroxidase complex, ×400).


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