HBME1 and CK19 Expression in Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) vs Other Follicular Patterned Thyroid Lesions

Authors

Qandeel Sadiq, Department of Pathology, Methodist University Hospital, University of Tennessee Health Sciences Center, Memphis, TN, USA
Radhika Sekhri, Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, NY, USA
Daniel T Dibaba, Tennessee Clinical and Translational Science Institute, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
Qi Zhao, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
Shweta Agarwal, Department of Pathology, University of New Mexico School of Medicine, MSC08 4640, 1 University of New Mexico, Albuquerque, NM, 87131, USA. shagarwal@salud.unm.edu

Document Type

Article

Publication Date

5-8-2021

Abstract

BACKGROUND: Thyroid neoplasms with follicular architecture can have overlapping morphologic features and pose diagnostic confusion among pathologists. Various immunohistochemical stains have been investigated as potential diagnostic markers for PTC, among which HBME1 and CK19 have gained popularity. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) poses similar diagnostic challenges with interobserver variability and is often misdiagnosed as adenomatoid nodule or follicular adenoma. This study aims to evaluate expression of HBME1 and CK19 in NIFTPs in comparison to other well-differentiated thyroid neoplasms and benign mimickers.

METHOD: Seventy-three thyroid cases diagnosed over a period of 3 years at Methodist University Hospital, Memphis, TN, USA, were included in this study: 9 NIFTP; 18 papillary thyroid carcinoma (PTC); 11 follicular variant of papillary thyroid carcinoma, invasive (I-FVPTC); 24 follicular adenomas (FA); and 11 multinodular goiters/adenomatoid nodules (MNG). A tissue microarray (TMA) was constructed and HBME1 and CK19 immunohistochemistry was performed.

RESULTS: 77.8% of NIFTPs, 88.9% of PTCs, 81.8% of I-FVPTCs, 16.7% of FAs, and 18.2% of MNGs showed HBME-1 expression. 66.7% of NIFTPs, 83.3% of PTCs, 81.8% of I-FVPTCs, 33.3% of FAs, and 45.4% of MNGs expressed CK19. Difference in expression of HBME1 and CK19 was statistically significant for NIFTP vs FA (qualitative; p < 0.05) and NIFTP vs MNG (p < 0.05). No statistically significant difference was found for HBME1 in NIFTP vs PTC (conventional and FVPTC), p ≥ 0.2. Sensitivity of HBME1 and CK19 for NIFTP were 78% and 67%, ~ 88% each for PTC, and 89% and 100% for FVPTC, respectively, while specificity of HBME1 and CK19 for NIFTP were 53% each, ~ 62% each for PTC, and ~55% each for FVPTC.

CONCLUSION: Our study indicated that HBME1 and CK19 are valuable markers in differentiating NIFTPs from morphologic mimics like follicular adenoma and adenomatoid nodules/multinodular goiter. While HBME1 and CK19 are both sensitive in diagnosing lesions with PTC-like nuclear features, CK19 stains a higher number of benign lesions in comparison to HBME1. No increase in sensitivity or specificity in diagnosis of NIFTP, PTC, or FVPTC was noted on combining the two antibodies.

Recommended Citation

Sadiq Q, Sekhri R, Dibaba DT, Zhao Q, Agarwal S. HBME1 and CK19 expression in non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) vs other follicular patterned thyroid lesions. World J Surg Oncol. 2021 May 8;19(1):143. doi: 10.1186/s12957-021-02258-7. PMID: 33964951; PMCID: PMC8106857.