Clin Exp Otorhinolaryngol.  2019 May;12(2):224-230. 10.21053/ceo.2018.01011.

Role of Immunohistochemistry in Fine Needle Aspiration and Core Needle Biopsy of Thyroid Nodules

• Song S
• Kim H
• Ahn SH

• KMID: 2447433
• DOI: http://doi.org/10.21053/ceo.2018.01011

Abstract

OBJECTIVES
Immunohistochemistry (IHC) has been used for the diagnosis of indeterminate results in fine needle aspiration (FNA) of thyroid nodules. However, the role of IHC in core needle biopsy (CNB) is not clear and the efficacy of testing for molecular markers following CNB has not been evaluated. The aim of this study is to compare the role of IHC staining in CNB with that in FNA when examining thyroid nodules and to compare the sensitivity and usefulness of different molecular markers.
METHODS
Consecutive cases of thyroid FNA and CNB accompanied by IHC from 2004 to 2014 were included in this study with retrospective review of medical record. The rate of remaining nondiagnostic result (unsatisfactory, atypia of undetermined significance or follicular lesion of undetermined significance [AUS/FLUS]) and rate of strong expression of each molecular marker according to the diagnosis were evaluated.
RESULTS
IHC was more frequently performed in CNB with multiple molecular markers compared to FNA (38.1% vs. 2.8%, 3 or 4 markers [Gal-3, HBME-1, CK19, and CD56] vs. 1 marker [Gal-3]). In the CNB group, 11.3% remained as AUS/FLUS after IHC, and the rate remaining nondiagnostic was significantly less than in the FNA group (42.9%). Gal-3 and CK19 showed higher specificity and expressed mainly in conventional type of papillary carcinoma and HBME-1 showed higher sensitivity for the diagnosis of carcinoma with expression in both conventional type and follicular variant papillary thyroid carcinoma.
CONCLUSION
With these data, we could conclude that IHC was more effective following CNB than following FNA.

Keyword

Thyroid Nodule; Core Needle Biopsy; Fine Needle Aspiration; Immunohistochemistry; Carcinoma

MeSH Terms

Biopsy, Fine-Needle*
Biopsy, Large-Core Needle*
Carcinoma, Papillary
Diagnosis
Immunohistochemistry*
Medical Records
Retrospective Studies
Sensitivity and Specificity
Thyroid Gland*
Thyroid Neoplasms
Thyroid Nodule*

Figure

• 

  Fig. 1. Flowchart of included cases with immunohistochemical staining (IHC). (A) IHC in fine needle aspiration (FNA) cases. (B) IHC in core needle biopsy (CNB) cases. US-FNA, ultrasound-guided fine needle aspiration; FA, follicular adenoma; FVPTC, follicular variant papillary thyroid carcinoma; FC, follicular carcinoma; US-CNB, ultrasound-guided core needle biopsy; PTC, papillary thyroid carcinoma. a)Indicates cases that still had no diagnosis after IHC staining.

• 

  Fig. 2. Heat map of expression of each molecular marker following fine-needle aspiration or core needle biopsy. (A) Expression according to preoperative diagnosis after immunohistochemistry. (B) Expression according to the surgical pathology.

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