The Value Of US-FNA Combined With Detection Of Galectin-3、HBME-1 In Diagnosis Of Benign And Malignant Thyroid Nodules

Objective To evaluate the value of ultrasound-guided fine needle aspiration(US-FNA)combined with detection of Galectin-3、HBME-1 in diagnosis of benign and malignant thyroid nodules.Methods 223 thyroid nodules from 209 patients who underwent US-FNA were prospectively selected during 2014.12-2016.2. Apply TI-RADS for the classification of each nodule. Each of the nodule used both conventional smear and liquid-based preparation,and used the latter to detect the expression of Galectin-3,HBME-1 by immunocytochemical staining. The results of FNA were evaluated by Bethesda System. To clarify whether each of the patient underwent surgery by follow-up. Analysis and compare the relation of FNA cytological results、histological results、TI-RADS and the expression of Galectin-3,HBME-1.Results(1) The rate of satisfaction by liquid-based preparation were 94.39%(421/446)in 223 nodules with immunocytochemical staining. The expression of Galectin-3:14 nodules were insufficient in cell count,70 nodules were negative and 139 nodules were positive. The expression of HBME-1:11 nodules were insufficient in cell count,78 nodules were negative and 134 nodules were positive. The positive rate of Galectin-3、HBME-1 were both significantly different(P=0.000)between categoryⅡ、categoryⅥ and categoryⅡⅢ、categoryⅤⅥ.(2) There were 122 malignant nodules and 13 benign nodules in 135 operative nodules. The sensitivity、specificity、positive likelihood ratio、negative likelihood ratio、false positive rate、false negative rate、diagnosis accuracy、OR value of TI-RADS were 73.77%、84.62%、4.80、0.31、15.38%、26.23%、58.39%、15.47;the sensitivity、specificity、positive likelihood ratio、negative likelihood ratio、false positive rate、false negative rate、diagnosis accuracy、OR value of combined detection of Galectin-3、HBME-1 were 81.15%、92.31%、10.55、0.20、7.69%、18.85%、73.46%、51.65.(3)In 34 indeterminate nodules,the sensitivity and specificity of US-FNA combined with detection of Galectin-3、HBME-1 and TI-RADS’ parallel test were 86.36%、75%,the sensitivity and specificity of US-FNA combined with detection of Galectin-3、HBME-1 and TI-RADS’ series test were 36.36%、100%.(4)There are 90 malignant nodules operative in our hospital, among them were 89 thyroid papillary carcinoma and 1 diffuse large B cell lymphoma. There were no significantly different on the positive rate of Galectin-3、HBME-1 of gender、age、nodules’ size、multifocality、thyroid capsular invasion and lymph node metastasis(P≥0.05).Conclusion(1)The liquid-based preparation has a relative high value for further immunocytochemical staining.(2)Galectin-3、HBME-1 were both strong and diffuse expression in large part of malignant nodules、weak expression or not in large part of benign nodules. The positive rate were significantly different between benign and malignant nodules.(3)US-FNA combined with TI-RADS and detection of Galectin-3、HBME-1 contributes to increase the diagnostic accuracy of thyroid nodules. US-FNA combined with detection of Galectin-3、HBME-1 was more efficient than US-FNA combined with TI-RADS. Combination of Galectin-3、HBME-1 was more efficient than only one marker in diagnosis.(4)US-FNA combined with detection of Galectin-3、HBME-1 and TI-RADS’ series test further decrease the misdiagnosis rate than US-FNA combined with detection of Galectin-3、HBME-1.(5)We haven’t find relationship between expression of Galectin-3、HBME-1 and the aggressive behavior of thyroid carcinoma. But the number of nodules enrolled was insufficient,we need collect more cases.