METHODS: MTCs with cytology and subsequent surgical follow-up were reviewed. Cytology slides were reviewed for mitotic figures, apoptoses, and necrosis, and a Ki67 PR was calculated when possible. Findings were correlated with final IMTCGS grade.
RESULTS: Twenty-five MTC fine-needle aspirations (FNAs) were identified, with nine identified as high grade (36%). By using a PR cutoff of 5%, Ki67 on FNA material (Ki67FNA) showed 92% concordance (n = 22 of 24) with surgical Ki67 and a correlation coefficient (R2) of 0.72. Sensitivity and specificity of Ki67FNA for predicting high-grade MTC were 38% and 100%, respectively. Multiple mitotic figures were present in a single slide of 43% (n = 3 of 7) of evaluable high-grade MTCs, whereas only one of 16 low-grade MTCs showed a single mitotic figure. Definitive apoptoses were present in five of seven high-grade MTC FNAs but were absent in 16 low-grade MTCs. The sensitivity and specificity of apoptoses/necrosis on cytology for high-grade MTCs were 71% and 88%, respectively.
CONCLUSIONS: Ki67FNA ≥5% shows low sensitivity but high specificity for predicting high-grade MTC. The presence of multiple mitotic figures in a single slide or definitive apoptotic bodies are both highly suggestive of high-grade MTC, and should warrant a close examination for necrosis and a careful Ki67 PR count.
方法:对MTCs的细胞学检查和随后的手术随访进行综述。检查细胞学切片的有丝分裂图,凋亡,和坏死,并在可能的情况下计算Ki67PR。结果与最终IMTCGS等级相关。
结果:确定了25个MTC细针穿刺(FNA),其中9人被确定为高等级(36%)。通过使用5%的PR截止值,FNA材料上的Ki67(Ki67FNA)与手术Ki67显示出92%的一致性(24个中的n=22),相关系数(R2)为0.72。Ki67FNA预测高级别MTC的敏感性和特异性分别为38%和100%,分别。43%(7个中的n=3)的可评估高级MTC的单个幻灯片中存在多个有丝分裂图,而16个低级别的MTC中只有一个显示出单一的有丝分裂图。明确的凋亡存在于七个高级MTCFNA中的五个中,但在16个低级MTC中却不存在。细胞凋亡/坏死对高级别MTC的敏感性和特异性分别为71%和88%,分别。
结论:Ki67FNA≥5%对预测高级别MTC的敏感性低,但特异性高。单个载玻片或确定的凋亡小体中存在多个有丝分裂图,都高度暗示了高级MTC,并且应该需要仔细检查坏死和仔细的Ki67PR计数。