title: Immunocytochemistry with cytokeratin 19 and anti-human mesothelial cell antibody (HBME1) increases the diagnostic accuracy of thyroid fine-needle aspirations: preliminary report of 150 liquid-based fine-needle aspirations with histological control.
abstract: BACKGROUND
  Thyroid nodules are relatively common (7% of the population) but are malignant in only 5%-10% of cases. Fine-needle aspiration (FNA) to detect cancer can have > 90% sensitivity but only 50%-65% specificity because of false-positive results, which necessitates surgical controls. We aimed to assess the diagnostic accuracy of immunocytochemistry (ICC) of thyroid FNA to improve its sensitivity and specificity.
  
  
  METHODS
  We prospectively collected 2038 thyroid FNAs, of which 1397 were FNA biopsies with liquid-based cytology (Thin-Prep-Hologic®). ICC with cytokeratin 19 and HBME1 antibodies (Dako® A/S) was used for all malignant cases and cases of atypical cells of undetermined significance (AUS), follicular neoplasm (FN), and nodules suspicious for malignancy-papillary thyroid carcinoma (SM-PTC) as well as some benign cases (abnormal features on radiography or benign on secondary FNA). ICC results were defined as "non-contributory," "favoring benign," "favoring malignant," or "indeterminate." Results for 150 cases were compared with histological controls for diagnostic accuracy.
  
  
  RESULTS
  Of these 150 cases ICC was helpful for benign or malignant triage of 48 cases of AUS, FN, and SM-PTC (42% of these lesions). Six (4%) ICC results were false positive (favoring malignant with benign histology) but none were false negative (favoring benign with malignant histology). Results for indeterminate cytological cases favored malignant or benign disease with sensitivity, specificity, and negative and positive predictive values of 100%, 85.2%, 100%, and 86.2%, respectively.
  
  
  CONCLUSIONS
  ICC of thyroid FNAs with cytokeratin 19 and HBME1 antibodies can reduce the false-positive and false-negative results of single morphological analyses. It can increase the sensitivity and specificity of diagnosis, thus improving diagnostic accuracy and reducing the need for surgical controls.
authors.affiliation: Department of Pathology and Cytopathology, Lariboisière Hospital, Paris, France.
authors.forename: Beatrix
authors.initials: B
authors.lastname: Cochand-Priollet
authors.forename: Henri
authors.initials: H
authors.lastname: Dahan
authors.forename: Marie
authors.initials: M
authors.lastname: Laloi-Michelin
authors.forename: Marc
authors.initials: M
authors.lastname: Polivka
authors.forename: Michele
authors.initials: M
authors.lastname: Saada
authors.forename: Philippe
authors.initials: P
authors.lastname: Herman
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Guillausseau
authors.forename: Lounis
authors.initials: L
authors.lastname: Hamzi
authors.forename: Nicolas
authors.initials: N
authors.lastname: Poté
authors.forename: Emile
authors.initials: E
authors.lastname: Sarfati
authors.forename: Michel
authors.initials: M
authors.lastname: Wassef
authors.forename: Herve
authors.initials: H
authors.lastname: Combe
authors.forename: Danielle
authors.initials: D
authors.lastname: Raulic-Raimond
authors.forename: Pierre
authors.initials: P
authors.lastname: Chedin
authors.forename: Virginie
authors.initials: V
authors.lastname: Medeau
authors.forename: Daniele
authors.initials: D
authors.lastname: Casanova
authors.forename: Romain
authors.initials: R
authors.lastname: Kania
mesh_terms: D018263:Adenocarcinoma, Follicular; D000888:Antibodies, Anti-Idiotypic / Q000378:metabolism; D014408:Biomarkers, Tumor / Q000276:immunology* / Q000378:metabolism; D044963:Biopsy, Fine-Needle; D002277:Carcinoma; D002291:Carcinoma, Papillary; D016022:Case-Control Studies; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D053539:Keratin-19 / Q000378:metabolism; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000378:metabolism / Q000473:pathology*; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D000951:Antigens, Neoplasm
chemical_list: D000888:Antibodies, Anti-Idiotypic; D014408:Biomarkers, Tumor; D053539:Keratin-19; C432845:HBME-1 antigen; D000951:Antigens, Neoplasm