Abstract：
BACKGROUND: Diagnosis of early mycosis fungoides (eMF) is challenging and often delayed as many of its clinical and histopathologic features may mimic various benign inflammatory dermatoses (BIDs). The products of the thymocyte selection-associated high mobility group box (TOX), twist family BHLH transcription factor 1 (TWIST1), signal transducer and activator of transcription 4 (STAT4), and special AT-rich sequence-binding protein 1 (SATB1) genes function as transcription factors and are involved in the pathogenesis of MF.
OBJECTIVE: We aim to determine the diagnostic value of TOX, TWIST1, STAT4, and SATB1 protein expressions in eMF.
METHODS: This non-randomized, controlled, prospective analytic study was conducted by performing immunohistochemistry staining with TOX, TWIST1, STAT4, and SATB1 polyclonal antibodies in lesional skin biopsies of eMF and BID patients. Nuclear staining of lymphocytes was compared between eMF and BIDs, and the capacity of these antibodies to predict eMF was determined.
RESULTS: Immunostainings with anti-TWIST1 showed an increase in protein expression (p = 0.003) and showed a decrease with anti-SATB1 antibodies in eMF compared to BIDs (p = 0.005) while anti-TOX and anti-STAT4 antibodies did not exhibit significant differences (p = 0.384; p = 0.150). Receiver operating characteristic analysis showed that immunohistochemical evaluations of TWIST1 and SATB1 protein expressions can differentiate eMF (area under the curve [AUC]: 0.728, 95% confidence interval [CI]: 0.605-0.851, p = 0.002; AUC: 0.686, 95% CI: 0.565-0.807, p = 0.013).
CONCLUSIONS: TWIST1 and SATB1 are potential diagnostic markers for the histologic diagnosis of eMF.
OBJECTIVE: We aim to determine the diagnostic value of TOX, TWIST1, STAT4, and SATB1 protein expressions in eMF.
METHODS: This non-randomized, controlled, prospective analytic study was conducted by performing immunohistochemistry staining with TOX, TWIST1, STAT4, and SATB1 polyclonal antibodies in lesional skin biopsies of eMF and BID patients. Nuclear staining of lymphocytes was compared between eMF and BIDs, and the capacity of these antibodies to predict eMF was determined.
RESULTS: Immunostainings with anti-TWIST1 showed an increase in protein expression (p = 0.003) and showed a decrease with anti-SATB1 antibodies in eMF compared to BIDs (p = 0.005) while anti-TOX and anti-STAT4 antibodies did not exhibit significant differences (p = 0.384; p = 0.150). Receiver operating characteristic analysis showed that immunohistochemical evaluations of TWIST1 and SATB1 protein expressions can differentiate eMF (area under the curve [AUC]: 0.728, 95% confidence interval [CI]: 0.605-0.851, p = 0.002; AUC: 0.686, 95% CI: 0.565-0.807, p = 0.013).
CONCLUSIONS: TWIST1 and SATB1 are potential diagnostic markers for the histologic diagnosis of eMF.
摘要：
背景：早期真菌菌病（eMF）的诊断具有挑战性，并且由于其许多临床和组织病理学特征可能模仿各种良性炎症性皮肤病（BID），因此通常会延迟诊断。胸腺细胞选择相关的高迁移率组盒（TOX）的产品，twist家族BHLH转录因子1(TWIST1),信号转导和转录激活因子4（STAT4），和特殊的富含AT的序列结合蛋白1（SATB1）基因起着转录因子的作用，并参与MF的发病机理。
目的：我们旨在确定TOX的诊断价值，TWIST1、STAT4和SATB1蛋白在eMF中的表达。
方法：这种非随机，控制,前瞻性分析研究通过用TOX进行免疫组织化学染色进行，eMF和BID患者皮损活检中的TWIST1、STAT4和SATB1多克隆抗体。在eMF和BID之间比较淋巴细胞的核染色，并确定这些抗体预测eMF的能力。
结果:使用抗TWIST1的免疫染色显示与BID相比,eMF中的抗SATB1抗体的蛋白质表达增加(p=0.003)并且显示降低(p=0.005),而抗TOX和抗STAT4抗体没有表现出显著差异(p=0.384;p=0.150)。受试者工作特征分析显示，TWIST1和SATB1蛋白表达的免疫组织化学评估可以区分eMF（曲线下面积[AUC]：0.728，95％置信区间[CI]：0.605-0.851，p=0.002；AUC：0.686，95％CI：0.565-0.807，p=0.013）。
结论：TWIST1和SATB1是eMF组织学诊断的潜在诊断标志物。
目的：我们旨在确定TOX的诊断价值，TWIST1、STAT4和SATB1蛋白在eMF中的表达。
方法：这种非随机，控制,前瞻性分析研究通过用TOX进行免疫组织化学染色进行，eMF和BID患者皮损活检中的TWIST1、STAT4和SATB1多克隆抗体。在eMF和BID之间比较淋巴细胞的核染色，并确定这些抗体预测eMF的能力。
结果:使用抗TWIST1的免疫染色显示与BID相比,eMF中的抗SATB1抗体的蛋白质表达增加(p=0.003)并且显示降低(p=0.005),而抗TOX和抗STAT4抗体没有表现出显著差异(p=0.384;p=0.150)。受试者工作特征分析显示，TWIST1和SATB1蛋白表达的免疫组织化学评估可以区分eMF（曲线下面积[AUC]：0.728，95％置信区间[CI]：0.605-0.851，p=0.002；AUC：0.686，95％CI：0.565-0.807，p=0.013）。
结论：TWIST1和SATB1是eMF组织学诊断的潜在诊断标志物。
