Immunohistochemical staining for thyroid peroxidase (TPO) of needle core biopsies in the diagnosis of scintigraphically cold thyroid nodules

• Published in: Clinical endocrinology (Oxford) Vol. 68; no. 6; pp. 996 - 1001
• Main Authors: Yousaf, U., Christensen, L. H., Rasmussen, Å. K., Jensen, F., Mollerup, C. L., Kirkegaard, J., Lausen, I., Rank, F., Feldt-Rasmussen, U.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.06.2008; Blackwell
• Subjects: Adenoma - diagnosis; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy, Needle; Carcinoma - diagnosis; Child; Endocrinopathies; Female; Fundamental and applied biological sciences. Psychology; Humans; Immunohistochemistry; Iodide Peroxidase - analysis; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Original; Sensitivity and Specificity; Staining and Labeling; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - enzymology; Thyroid Nodule - diagnosis; Thyroid. Thyroid axis (diseases); Vertebrates: endocrinology; Young Adult; Endocrinopathy; Immunohistochemistry; Enzyme; Thyroid diseases; Staining; Iodide peroxidase; Cold nodule; Thrombopoietin; Anatomic pathology; Peroxidases; Biopsy; Needle; Thyroid nodule; Oxidoreductases; Diagnosis; Endocrinology
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/j.1365-2265.2007.03130.x

Summary Background  Cold thyroid nodules are common, in particular in iodine‐deficient areas, but only a minority of them are malignant requiring surgery. Thyroid peroxidase (TPO) immunostaining of fine‐needle aspiration cytology (FNAC) material has proven helpful in diagnosing cells from malignant lesions, but the procedure has its limitations in a routine setting. Purpose  To improve diagnosis and reduce surgery rate, the FNAC procedure was replaced by needle core biopsy (NCB), which was routinely stained for TPO by the monoclonal antibody mAb 47. Materials and methods  During a 5‐year period 427 consecutive patients with a cold thyroid nodule were evaluated by ultrasound‐guided NCB, which had been routinely stained for TPO in an automated immunostainer. Sensitivity and specificity and predictive values of the TPO immunostaining were estimated, based on the final diagnosis obtained from surgical resection. Results  The majority of nodules with benign NCB diagnosis were not surgically removed, and thus a subgroup of 140 operated nodules formed the basis for the calculations. Sensitivity and specificity for benign and malignant lesions were 100% if the oxyphilic variant of adenomas and minimally invasive follicular carcinomas were excluded. By inclusion of these, the values fell to 89% and 97%, respectively. The predictive value of a positive test was 96% and the predictive value of a negative test was 97%. Conclusion  TPO immunostaining was found to be a valuable adjunct to morphology in the diagnosis of cold thyroid nodules of the nonoxyphilic type.