Background: The cytological discrimination between benign and malignant follicular-patterned lesions of the thyroid can represent a diagnostic challenge, even for experienced pathologists. We evaluated the diagnostic use of protein expression of CXC chemokine receptor 4 (CXCR4) and galectin-3 (gal-3) that were found to be upregulated in papillary thyroid carcinoma compared to normal thyroid and of mesothelial cell surface protein recognized by monoclonal antibody Hector Battifora Mesothelial cell (HBME)-1 in thyroid tumors.
Methods: Expression of CXCR4, HBME-1, and gal-3 was examined immunohistochemically in total of 100 aspirates of thyroid lesions, categorized as benign (n = 22), indeterminate lesion (n = 43), suspicious of papillary thyroid carcinoma (n = 10), or malignant (n = 25) by preoperative cytology.
Results: Expression of each individual marker was significantly associated with malignancy (p < 0.0001), although the sensitivity of detection ranged from 56% for gal-3 to 94% for HBME-1. When focusing on the indeterminate lesions, only CXCR4 and HBME-1 expression was associated with malignancy; moreover, these two markers either used individually or in combination showed good values of diagnostic accuracy (88.4% and 90.7%, respectively). Further, the combination of CXCR4 plus HBME-1 or the simultaneous use of all the three markers provided absolute value of sensitivity and negative predictive value in the same group of lesions.
Conclusions: An immunohistochemical panel, including CXCR4, could be useful in the differential diagnosis between benign and malignant well-differentiated follicular-patterned thyroid lesions.