RESUMEN
BACKGROUND: Fine-needle aspiration biopsy (FNAB) is the most accurate study in the preoperative evaluation of patients with thyroid nodules. However, one of its limitations is the indeterminate or suspicious sample which accounts for 15% to 25% of the cases; both follicular and Hürthle cell neoplasms are included in this category. OBJECTIVE: To assess the accuracy of the molecular markers HBME-1 and galectin-3 in suspicious or indeterminate FNABs comparing the results with the histologic diagnosis of the thyroidectomy specimen. MATERIALS AND METHODS: A prospective study was carried out at 2 Health Centers in Santiago, Chile. From July 2003 to March 2008, 418 FNABs with indeterminate or suspicious diagnosis were immunostained with HBME-1 and galectin-3. Immunohistochemistry was performed on a clot obtained by FNAB, which was formalin-fixed and paraffin-embedded. The results were matched with the definitive histologic diagnosis of the thyroidectomy specimen. RESULTS: Of 418 patients submitted to FNAB with immunohistochemistry, 138 patients underwent surgery. The sensitivity, specificity, positive predictive value, and negative predictive value were 78.67%, 84.13%, 85.51%, and 76.81%, respectively, for HBME-1 and 82.67%, 80.95%, 83.78%, and 79.69%, respectively, for galectin-3. Whereas the results for both markers combined were 94.74%, 75.81%, 82.76%, and 92.16%. CONCLUSIONS: With the combined use of HBME-1 and galectin-3 in indeterminate FNABs, a 10% increase in sensitivity is achieved. These markers show excellent sensitivity and specificity and may improve patient's selection for surgery.
Asunto(s)
Biomarcadores de Tumor/análisis , Galectina 3/análisis , Neoplasias de la Tiroides/diagnóstico , Biopsia con Aguja Fina , Humanos , Estudios Prospectivos , Sensibilidad y Especificidad , Neoplasias de la Tiroides/patologíaRESUMEN
Human T-cell lymphotropic virus type I (HTLV-I)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been associated with changes in extracellular matrix of neural tissue. HTLV-I infection has multiple other systemic effects. Extracellular matrix is important for bone mineral deposition. We examined bone mineral density (BMD) in patients with HAM/TSP. BMD was assessed by ultrasonographic calcaneous densitometry in 24 patients (7 males, 17 females) with HAM/TPS, and 23 healthy HTLV-I-seronegative controls matched by age and sex. Patients with HAM/TPS had a mean BMD T-score of -3.07 +/- 0.64 in males and -2.93 +/- 0.69 in females. Control patients revealed a T-score of -0.77 +/- 1.31 in males and -1.17 +/- 1.08 females. The difference in T-score between HAM/TSP patients and control groups is significant (P < 0.001). Of HAM/TPS patients, 7 of 24 (29.2%) had osteopenia (T-score between -1 and -2.5) and 17 of 24 (70.8%) were diagnosed with osteoporosis (T < -2.5). Respective figures for control patients were 10 of 23 (43.5%) with a normal T-score, 11 of 23 (47.8%) with osteopenia, and 2 of 23 (8.7%) with osteoporosis. After adjustment for age and sex, odds ratio of osteoporosis for HAM/TSP patients was 31.52 (95% confidence interval, 5.07 to 195.88). No correlation was found in HAM/TSP patients between T-score and age, menstrual status, gait functionality, or years of evolution of HAM/TSP. HAM/TSP patients have a significantly diminished BMD of the calcaneous that appears not to be explained by paresis, age, years of disease, menstrual status; may be the result of systemic alterations due to HTLV-1 infection.