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Лабораторная диагностика опухолевых заболеваний щитовидной железы
Абросимов А.Ю., Абдулхабирова Ф.М., Никанкина Л.В., Трошина Е.А. Лабораторная диагностика опухолевых заболеваний щитовидной железы. Consilium Medicum. 2019; 21 (12): 31–47. DOI: 10.26442/20751753.2019.12.190682
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Abrosimov A.Iu., Abdulkhabirova F.M., Nikankina L.V., Troshina E.A. Laboratory diagnosis of thyroid neoplasms. Consilium Medicum. 2019; 21 (12): 31–47. DOI: 10.26442/20751753.2019.12.190682
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Аннотация
В методическом пособии подробно освещаются все основные методы современной лабораторной диагностики опухолей щитовидной железы.
Key words: thyroid gland, neoplasms, laboratory and morphological diagnostics.
Обсуждаются конструктивные изменения в концепции диагностики, анализируются обновленная гистологическая классификация опухолей щитовидной железы и цитологическая классификация Бетесда. Рассматриваются новые технологии и перспективные направления работы лабораторной службы для дифференциальной диагностики доброкачественных и злокачественных образований щитовидной железы. Демонстрируются примеры цитологической и гистологической диагностики различных новообразований щитовидной железы, включающих редкие формы опухолей. Рекомендуется для эндокринологов, специалистов клинической лабораторной диагностики, патологоанатомов, врачей общей практики.
Ключевые слова: щитовидная железа, новообразования, лабораторная и морфологическая диагностика.
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The guideline describes in detail all the basic methods of modern laboratory diagnosis of thyroid neoplasms. Significant changes in the diagnostic concept are discussed and the updated histological classification of thyroid neoplasms and the Bethesda cytological classification are analyzed. New technologies and promising areas of the laboratory service for the differential diagnosis of benign and malignant thyroid tumors are also considered. The guideline provides examples of cytological and histological diagnosis of various neoplasms of the thyroid gland, including rare forms of tumors. The guideline is intended for use by endocrinologists, specialists in clinical laboratory diagnostics, pathologists and general practitioners.
Полный текст
Список литературы
1. WHO Classification of tumours of endocrine organs. 4th ed. Eds. Lloyd RV, Osamura RY, Klöppel G, Rosai J. Lyon: IARC, 2017.
2. Elisei R, Bottici V, Luchetti F et al. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab 2004; 89: 163–8.
3. Hahm JR, Lee MS, Min YK et al. Routine measurement of serum calcitonin is useful for early detection of medullary thyroid carcinoma in patients with nodular thyroid diseases. Thyroid 2001; 11: 73–80.
4. Бельцевич Д.Г., Ванушко В.Э., Мельниченко Г.А. и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению (много)узлового зоба у взрослых (2015 год). Эндокринная хирургия. 2016; 1 (10): 5–12.
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6. Elisei R, Romei C. Calcitonin estimation in patients with nodular goiter and its significance for early detection of MTC: european comments to the guidelines of the American Thyroid Association. Thyroid Research 2013; 6 (Suppl. 1): S2.
7. Спенсер К.Э. Современные принципы оценки уровня тиреоглобулина при наблюдении пациентов с высокодифференцированным раком щитовидной железы. Thyroid International 2003; 4: 1–16.
[Spenser K.E. Sovremennye printsipy otsenki urovnia tireoglobulina pri nabliudenii patsientov s vysokodifferentsirovannym rakom shchitovidnoi zhelezy. Thyroid International. 2003; 4: 1–16 (in Russian).]
8. Bournaud C, Charrie A, Nozieres C et al. Thyroglobulin measurement in fine-needle aspirates of lymphnodes in patients with differentiated thyroid cancer: a simple definition of the threshold value, with emphasis on potential pitfalls of the method. Clin Chem Lab Med 2010; 48 (8): 1171–7.
9. Piaggio-Blanco RA, Paseyro P, Grosso OF. El citogramma tiroideo; su interes clinic. Arcg Drug Med 1948; 32: 82–5.
10. Семкина Г.В., Смирнова В.А., Абдулхабирова Ф.М., Ванушко В.Э. Роль тонкоигольной аспирационной биопсии в динамическом наблюдении пациентов с узловым зобом. Клин. и эксперим. тиреоидология. 2012; 8 (3): 30–43.
[Semkina G.V., Smirnova V.A., Abdulkhabirova F.M., Vanushko V.E. Rol' tonkoigol'noi aspiratsionnoi biopsii v dinamicheskom nabliudenii patsientov s uzlovym zobom. Klin. i eksperim. tireoidologiia. 2012; 8 (3): 30–43 (in Russian).]
11. Ali ZS, Cibas ES. The Bethesda System For Reporting Thyroid Cytopathology – Springler International Publishing AG, 2010.
12. Sheffield BS, Masoudi H, Walker B, Wiseman SM. Preoperative diagnosis of thyroid nodules using the Bethesda system for reporting thyroid cytopathology: a comprehensive review and meta-analysis. Exp Rev Endo Metab 2014; 9: 97–110.
13. Haugen BR, Alexander EK, Bible KC et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 1: 1–147.
14. Ali SZ, Cibas ES. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria, and Explanatory Springer International Publishing AG, 2018.
15. Strickland KC, Howitt BE, Marqusee E et al. The impact of noninvasive follicular variant of papillary thyroid carcinoma on rates of malignancy for fine-needle aspiration diagnostic categories. Thyroid 2015; 25 (9): 987–92.
16. Faquin WC, Wong LQ, Afrogheh AH et al. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in the Bethesda system for reporting thyroid cytopathology. Cancer Cytopathol 2016; 124: 181–7.
17. Шабалова И.П., Касоян К.Т., Савостикова М.В. Жидкостная цитология в клинической практике. Клиническая лабораторная диагностика. 2011; 12: 25–35.
[Shabalova I.P., Kasoian K.T., Savostikova M.V. Zhidkostnaia tsitologiia v klinicheskoi praktike. Klinicheskaia laboratornaia diagnostika. 2011; 12: 25–35 (in Russian).]
18. Casey MB, Lohse CM, Lloyd RV. Distinction between papillary thyroid hyperplasia and papillary thyroid carcinoma by immunohistochemical staining for cytokeratin 19, galectin 3 and HBME 1. Endocrine Pathol 2003; 14: 55–60.
19. Bryson PC, Shores CG, Hart C et al. Immunohistochemical distinction of follicular thyroid adenomas and follicular carcinomas. Arch. Otolaryngol. Head Neck Surg 2008; 134 (6): 581–6.
20. Alexander EK, Schorr M, Klopper J et al. Multicenter clinical experience with the Afirma gene expression classifier. J Clin Endocrinol Metab 2014; 99: 119–25.
21. Chan JKC, Rosai J. Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept. Human Pathol 1991; 22: 349–3.
2. Elisei R, Bottici V, Luchetti F et al. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab 2004; 89: 163–8.
3. Hahm JR, Lee MS, Min YK et al. Routine measurement of serum calcitonin is useful for early detection of medullary thyroid carcinoma in patients with nodular thyroid diseases. Thyroid 2001; 11: 73–80.
4. Бельцевич Д.Г., Ванушко В.Э., Мельниченко Г.А. и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению (много)узлового зоба у взрослых (2015 год). Эндокринная хирургия. 2016; 1 (10): 5–12.
[Bel'tsevich D.G., Vanushko V.E., Mel'nichenko G.A et al. Klinicheskie rekomendatsii Rossiiskoi assotsiatsii endokrinologov po diagnostike i lecheniiu (mnogo)uzlovogo zoba u vzroslykh (2015 god). Endokrinnaia khirurgiia. 2016; 1 (10): 5–12 (in Russian).]
5. Бельцевич Д.Г., Ванушко В.Э., Румянцев П.О. и др. Российские клинические рекомендации по диагностике и лечению высокодифференцированного рака щитовидной железы у взрослых. Эндокринная хирургия. 2017; 1 (11): 6–27.
[Bel'tsevich D.G., Vanushko V.E., Rumiantsev P.O. et al. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniiu vysokodifferentsirovannogo raka shchitovidnoi zhelezy u vzroslykh. Endokrinnaia khirurgiia. 2017; 1 (11): 6–27 (in Russian).]
6. Elisei R, Romei C. Calcitonin estimation in patients with nodular goiter and its significance for early detection of MTC: european comments to the guidelines of the American Thyroid Association. Thyroid Research 2013; 6 (Suppl. 1): S2.
7. Спенсер К.Э. Современные принципы оценки уровня тиреоглобулина при наблюдении пациентов с высокодифференцированным раком щитовидной железы. Thyroid International 2003; 4: 1–16.
[Spenser K.E. Sovremennye printsipy otsenki urovnia tireoglobulina pri nabliudenii patsientov s vysokodifferentsirovannym rakom shchitovidnoi zhelezy. Thyroid International. 2003; 4: 1–16 (in Russian).]
8. Bournaud C, Charrie A, Nozieres C et al. Thyroglobulin measurement in fine-needle aspirates of lymphnodes in patients with differentiated thyroid cancer: a simple definition of the threshold value, with emphasis on potential pitfalls of the method. Clin Chem Lab Med 2010; 48 (8): 1171–7.
9. Piaggio-Blanco RA, Paseyro P, Grosso OF. El citogramma tiroideo; su interes clinic. Arcg Drug Med 1948; 32: 82–5.
10. Семкина Г.В., Смирнова В.А., Абдулхабирова Ф.М., Ванушко В.Э. Роль тонкоигольной аспирационной биопсии в динамическом наблюдении пациентов с узловым зобом. Клин. и эксперим. тиреоидология. 2012; 8 (3): 30–43.
[Semkina G.V., Smirnova V.A., Abdulkhabirova F.M., Vanushko V.E. Rol' tonkoigol'noi aspiratsionnoi biopsii v dinamicheskom nabliudenii patsientov s uzlovym zobom. Klin. i eksperim. tireoidologiia. 2012; 8 (3): 30–43 (in Russian).]
11. Ali ZS, Cibas ES. The Bethesda System For Reporting Thyroid Cytopathology – Springler International Publishing AG, 2010.
12. Sheffield BS, Masoudi H, Walker B, Wiseman SM. Preoperative diagnosis of thyroid nodules using the Bethesda system for reporting thyroid cytopathology: a comprehensive review and meta-analysis. Exp Rev Endo Metab 2014; 9: 97–110.
13. Haugen BR, Alexander EK, Bible KC et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 1: 1–147.
14. Ali SZ, Cibas ES. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria, and Explanatory Springer International Publishing AG, 2018.
15. Strickland KC, Howitt BE, Marqusee E et al. The impact of noninvasive follicular variant of papillary thyroid carcinoma on rates of malignancy for fine-needle aspiration diagnostic categories. Thyroid 2015; 25 (9): 987–92.
16. Faquin WC, Wong LQ, Afrogheh AH et al. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in the Bethesda system for reporting thyroid cytopathology. Cancer Cytopathol 2016; 124: 181–7.
17. Шабалова И.П., Касоян К.Т., Савостикова М.В. Жидкостная цитология в клинической практике. Клиническая лабораторная диагностика. 2011; 12: 25–35.
[Shabalova I.P., Kasoian K.T., Savostikova M.V. Zhidkostnaia tsitologiia v klinicheskoi praktike. Klinicheskaia laboratornaia diagnostika. 2011; 12: 25–35 (in Russian).]
18. Casey MB, Lohse CM, Lloyd RV. Distinction between papillary thyroid hyperplasia and papillary thyroid carcinoma by immunohistochemical staining for cytokeratin 19, galectin 3 and HBME 1. Endocrine Pathol 2003; 14: 55–60.
19. Bryson PC, Shores CG, Hart C et al. Immunohistochemical distinction of follicular thyroid adenomas and follicular carcinomas. Arch. Otolaryngol. Head Neck Surg 2008; 134 (6): 581–6.
20. Alexander EK, Schorr M, Klopper J et al. Multicenter clinical experience with the Afirma gene expression classifier. J Clin Endocrinol Metab 2014; 99: 119–25.
21. Chan JKC, Rosai J. Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept. Human Pathol 1991; 22: 349–3.
________________________________________________
1. WHO Classification of tumours of endocrine organs. 4th ed. Eds. Lloyd RV, Osamura RY, Klöppel G, Rosai J. Lyon: IARC, 2017.
2. Elisei R, Bottici V, Luchetti F et al. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid cancer: experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab 2004; 89: 163–8.
3. Hahm JR, Lee MS, Min YK et al. Routine measurement of serum calcitonin is useful for early detection of medullary thyroid carcinoma in patients with nodular thyroid diseases. Thyroid 2001; 11: 73–80.
4. Bel'tsevich D.G., Vanushko V.E., Mel'nichenko G.A et al. Klinicheskie rekomendatsii Rossiiskoi assotsiatsii endokrinologov po diagnostike i lecheniiu (mnogo)uzlovogo zoba u vzroslykh (2015 god). Endokrinnaia khirurgiia. 2016; 1 (10): 5–12 (in Russian).
5. Bel'tsevich D.G., Vanushko V.E., Rumiantsev P.O. et al. Rossiiskie klinicheskie rekomendatsii po diagnostike i lecheniiu vysokodifferentsirovannogo raka shchitovidnoi zhelezy u vzroslykh. Endokrinnaia khirurgiia. 2017; 1 (11): 6–27 (in Russian).
6. Elisei R, Romei C. Calcitonin estimation in patients with nodular goiter and its significance for early detection of MTC: european comments to the guidelines of the American Thyroid Association. Thyroid Research 2013; 6 (Suppl. 1): S2.
7. Spenser K.E. Sovremennye printsipy otsenki urovnia tireoglobulina pri nabliudenii patsientov s vysokodifferentsirovannym rakom shchitovidnoi zhelezy. Thyroid International. 2003; 4: 1–16 (in Russian).
8. Bournaud C, Charrie A, Nozieres C et al. Thyroglobulin measurement in fine-needle aspirates of lymphnodes in patients with differentiated thyroid cancer: a simple definition of the threshold value, with emphasis on potential pitfalls of the method. Clin Chem Lab Med 2010; 48 (8): 1171–7.
9. Piaggio-Blanco RA, Paseyro P, Grosso OF. El citogramma tiroideo; su interes clinic. Arcg Drug Med 1948; 32: 82–5.
10. Semkina G.V., Smirnova V.A., Abdulkhabirova F.M., Vanushko V.E. Rol' tonkoigol'noi aspiratsionnoi biopsii v dinamicheskom nabliudenii patsientov s uzlovym zobom. Klin. i eksperim. tireoidologiia. 2012; 8 (3): 30–43 (in Russian).
11. Ali ZS, Cibas ES. The Bethesda System For Reporting Thyroid Cytopathology – Springler International Publishing AG, 2010.
12. Sheffield BS, Masoudi H, Walker B, Wiseman SM. Preoperative diagnosis of thyroid nodules using the Bethesda system for reporting thyroid cytopathology: a comprehensive review and meta-analysis. Exp Rev Endo Metab 2014; 9: 97–110.
13. Haugen BR, Alexander EK, Bible KC et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 1: 1–147.
14. Ali SZ, Cibas ES. The Bethesda System for Reporting Thyroid Cytopathology: Definitions, Criteria, and Explanatory Springer International Publishing AG, 2018.
15. Strickland KC, Howitt BE, Marqusee E et al. The impact of noninvasive follicular variant of papillary thyroid carcinoma on rates of malignancy for fine-needle aspiration diagnostic categories. Thyroid 2015; 25 (9): 987–92.
16. Faquin WC, Wong LQ, Afrogheh AH et al. Impact of reclassifying noninvasive follicular variant of papillary thyroid carcinoma on the risk of malignancy in the Bethesda system for reporting thyroid cytopathology. Cancer Cytopathol 2016; 124: 181–7.
17. Shabalova I.P., Kasoian K.T., Savostikova M.V. Zhidkostnaia tsitologiia v klinicheskoi praktike. Klinicheskaia laboratornaia diagnostika. 2011; 12: 25–35 (in Russian).
18. Casey MB, Lohse CM, Lloyd RV. Distinction between papillary thyroid hyperplasia and papillary thyroid carcinoma by immunohistochemical staining for cytokeratin 19, galectin 3 and HBME 1. Endocrine Pathol 2003; 14: 55–60.
19. Bryson PC, Shores CG, Hart C et al. Immunohistochemical distinction of follicular thyroid adenomas and follicular carcinomas. Arch. Otolaryngol. Head Neck Surg 2008; 134 (6): 581–6.
20. Alexander EK, Schorr M, Klopper J et al. Multicenter clinical experience with the Afirma gene expression classifier. J Clin Endocrinol Metab 2014; 99: 119–25.
21. Chan JKC, Rosai J. Tumors of the neck showing thymic or related branchial pouch differentiation: a unifying concept. Human Pathol 1991; 22: 349–3.
Авторы
А.Ю. Абросимов*, Ф.М. Абдулхабирова, Л.В. Никанкина, Е.А. Трошина
ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
*nikitarusskikh@mail.ru
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Aleksandr Iu. Abrosimov*, Fatima M. Abdulkhabirova, Larisa V. Nikankina, Ekaterina A.
Troshina
*nikitarusskikh@mail.ru
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