갑상샘 세침흡인검사에서 SurePathTM 액상세포검사의 임상적 유용성에 대한 연구: 고식적 도말검사와의 비교 및 BRAF 유전자변이검사의 적용 = Clinical Usefulness of SurePathTM Liquid-based Cytology in Thyroid Fine Needle Aspiration:Comparison with the Conventional Smear in Diagnostic Efficacy and Applicability of BRAF Mutation Test

다국어 초록 (Multilingual Abstract)

Background: Recently, liquid-based cytology (LBC) has been introduced as an alternative to the conventional smear (CS) technique in thyroid fine needle aspiration, due to its diagnostic conve­nience. Methods: We assessed 77 cases of thyroid fine needle aspiration using the SurePathTM method (SP) as LBC and CS via split-sample techniques. BRAF mutation tests were carried out via polymerase chain reaction and pyrosequencing immediately after diagnosis or a delay of more than one year. Results: In a comparison between SP and CS, the rate of concordance between SP and CS was as high as 84.4% (kappa value, 0.754). In comparison with histologic diagnosis, the overall sensitivity was 100% for both. The specificity was 62.5% for SP and 56.3% for CS. Relative to CS, papillary carcinomas on SP slides revealed more accentuated nuclear irregulari­ties, nucleoli, and reduced nuclear size. In contrast to CS, the delayed BRAFV600E mutation test using SP slides after 1-2 years failed. The use of new primers amplifying shorter product size could help the delayed test achieve success. Conclusions: Differences in the diagnostic efficacy of SP and CS were negligible. The failure of the delayed BRAF mutation test on the SP slides might be associated with DNA degradation.

참고문헌 (Reference)

1 김동훈, "초음파 유도 갑상샘 세침흡인 세포검사에서 SurePathTM 액상세포검사의 유용성; 고식적 도말검사와 SurePathTM 액상세포검사와의 비교" 대한세포병리학회 18 (18): 143-152, 2007

2 김지영, "갑상샘과 유방 세침흡인의 액상 세포검사" 대한병리학회 43 (43): 99-106, 2009

3 Frost AR, "Utility of thin-layer preparations in thyroid fine-needle aspiration: diagnostic accuracy, cytomorphology, and optimal sample preparation" 84 : 17-25, 1998

4 Malle D, "Use of a thin-layer technique in thyroid fine needle aspiration" 50 : 23-27, 2006

5 Cochand-Priollet B, "Thyroid fine needle aspiration: the morphological features on ThinPrep slide preparations. Eighty cases with histological control" 14 : 343-349, 2003

6 Tulecke MA, "ThinPrep for cytologic evaluation of follicular thyroid lesions: correlation with histologic findings" 30 : 7-13, 2004

7 Scurry JP, "Thin layer compared to direct smear in thyroid fine needle aspiration" 11 : 104-115, 2000

8 Stamataki M, "The role of liquid-based cytology in the investigation of thyroid lesions" 19 : 11-18, 2008

9 Crippa S, "The Bethesda System for reporting thyroid fine-needle aspiration specimens" 134 : 343-344, 2010

10 Kim TY, "The BRAF mutation is useful for prediction of clinical recurrence in low-risk patients with conventional papillary thyroid carcinoma" BLACKWELL PUBLISHING 65 : 364-368, 2006

11 Jung CK, "Split sample comparison of a liquid-based method and conventional smears in thyroid fine needle aspiration" SCI PRINTERS & PUBL INC 52 : 313-319, 2008

12 King JR, "Recommendations on the use of alcohols for preservation of ant specimens (Hymenoptera, Formicidae)" 51 : 197-202, 2004

13 Kim SK, "Pyrosequencing analysis for detection of a BRAF(V600E) mutation in an FNAB specimen of thyroid nodules" LIPPINCOTT WILLIAMS & WILKINS 17 : 118-125, 2008

14 Fadda G, "Diagnostic efficacy of immunocytochemistry on fine needle aspiration biopsies processed by thin-layer cytology" 50 : 129-135, 2006

15 Rossi ED, "Diagnostic efficacy of conventional as compared to liquid-based cytology in thyroid lesions: evaluation of 10,360 fine needle aspiration cytology cases" 53 : 659-666, 2009

16 Chung KW, "Detection of BRAFV600E mutation on fine needle aspiration specimens of thyroid nodule refines cyto-pathology diagnosis, especially in BRAF600E mutation-prevalent area" 65 : 660-666, 2006

17 Lee HJ, "Detection of BRAF Mutations in Thyroid Nodules by Allele-Specific PCR Using a Dual Priming Oligonucleotide System" American Society for Clinical Pathology 133 : 802-808, 2010

18 Afify AM, "Cytologic artifacts and pitfalls of thyroid fine-needle aspiration using ThinPrep: a comparative retrospective review" 93 : 179-186, 2001

19 Dillon N, "Comparison of preservation techniques for DNA extraction from hymenopterous insects" 5 : 21-24, 1996

20 Kim SK, "Clinical and pathological features and the BRAF(V600E) mutation in patients with papillary thyroid carcinoma with and without concurrent Hashimoto thyroiditis" 19 : 137-141, 2009

21 Cheung CC, "Analysis of ret/PTC gene rearrangements refines the fine needle aspiration diagnosis of thyroid cancer" 86 : 2187-2190, 2001