Objective: Thyroid nodules which are common in population consist of mostly benign nodules and less malignant neoplasms. Differentiating malignant nodules from each other arises a drastic problem in making a correct diagnosis Thus,this study was done to investigate the role of CD56 and its specificity and sensitivity in different types of thyroid neoplasms especially papillary carcinoma.
Methods: 73 paraffin embedded-blocks of thyroid massses (nodules) were studied for CD56 immunohistologically from Imam Khomeini hospital ,Sari,Mazandaran.The 4-scaled semiquantitative method (0-3) was applied to estimate CD56 expression in tumor cells less than 10% (0) or negative staining, 10-33% (1), 33-66% (2), more than 66% (3).
Results: In this study 24.7% were male and 75.3% were female. 13.7% ,68.5 % and 17.8% of patients were less than 20, between 20- 50,and over 50 years old respectively.Simultaneously 50(68.5%) patients had both right and left lobes nodules.12(16.4%) ,6(8.2%)and 1(1.4%) patients had nodules in right and left lobes and isthmus respectively.Consequently, 4 (5.5%)patients showed left and right lobes ,and ithsmus nodules simultaneousely. There was no statistically significant difference between the sexes and ages and also anatomical regions in patients with and without PTC. 30 out of the 73 patients had papillary carcinoma(PTC) which 4 out of them expressed CD56 while 37 out of 43(86%) patients who had non-PTC showed positive results for CD56.Sensivity and specificity of negative result of CD56,positive predictive value(PPV) and negative predictive value(NPV) in the diagnosis of papillary carcinoma were 86.6%,86%,81.2% and 86.3% respectively.
Conclusion: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of negative result of CD56 in the diagnosis of PTC were 86.6%, 86.04%, 81.25%, 90.24% and 86.3% respectively. This study showed that CD56 was a valuable sensitive and specific marker in differentiating PTC from other thyroid tumors.
1. 1.Gharib H, Papini E. Thyroid nodules: clinical importance, assessment, and treatment. Endocrinol Metab Clin North Am. 2007;36 (3):707-35.
2.Topliss D. Thyroid incidentaloma : the ignorant in pursuit of the impalpable. Clin Endocrinol (Oxf). 2004;60 (1):18-20.
3.Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the US, 1985‐1995.j Cancer. 1998;83 (12):2638-48.
4.DeLellis R, Williams E. Thyroid and parathyroid tumors. Pathology and Genetics of Tumours of Endocrine Organs IARC WHO Classification of Tumours DeLellis RA, Lloyd RV, Heitz PU, and Eng C (eds) Lyons, France: IARC Press. 2004;12(2):51-6.
5.Nasr MR, Mukhopadhyay S, Zhang S, Katzenstein A-LA. Immunohistochemical markers in diagnosis of papillary thyroid carcinoma: utility of HBME1 combined with CK19 immunostaining. Mod Pathol. 2006;19 (12):1631-7.
6.Lloyd RV, Erickson LA, Casey MB, Lam KY, Lohse CM, Asa SL, et al. Observer variation in the diagnosis of follicular variant of papillary thyroid carcinoma. The American journal of surgical pathology. 2004;28 (10):1336-40.
7.Liu YY, Morreau H, Kievit J, Romijn JA, Carrasco N, Smit JW. Combined immunostaining with galectin-3, fibronectin-1, CITED-1, Hector Battifora mesothelial-1, cytokeratin-19, peroxisome proliferator-activated receptor-γ, and sodium/iodide symporter antibodies for the differential diagnosis of non-medullary thyroid carcinoma. European Journal of Endocrinology. 2008;158(3):375-84.
8.Haugen BR, Woodmansee WW, McDermott MT. Towards improving the utility of fine‐needle aspiration biopsy for the diagnosis of thyroid tumours. Clin Endocrinol (Oxf). 2002;56 (3):281-90.
9.Zeromski J, Lawniczak M, Galbas K, Jenek R, Golusiński P. Expression of CD56/N-CAM antigen and some other adhesion molecules in various human endocrine glands. Folia histochemica et cytobiologica/Polish Academy of Sciences, Polish Histochemical and Cytochemical Society. 1997; 36 (3):119-25.
10.Park WY, Jeong SM, Lee JH, Kang HJ, Sin DH, Choi KU, et al. Diagnostic value of decreased expression of CD56 protein in papillary carcinoma of the thyroid gland. J Basic and Applied Pathology. 2009;2 (2):63-8.
11.El Demellawy D, Nasr AL, Babay S, Alowami S. Diagnostic utility of CD56 immunohistochemistry in papillary carcinoma of the thyroid.J Pathology-Research and Practice. 2009; 205(5):303-9.
12.Migita K, Eguchi K, Kawakami A, Ida H, Fukuda T, Kurata A, et al. Detection of Leu-19 (CD56) antigen on human thyroid epithelial cells by an immunohistochemical method.J Immunology.1991;72(2):246.
13.El Demellawy D, Nasr A, Alowami S. Application of CD56, P63 and CK19 immunohistochemistry in the diagnosis of papillary carcinoma of the thyroid. J Diagn Pathol. 2008; 3(5).213-18.
14.Scarpino S, Di Napoli A, Melotti F, Talerico C, Cancrini A, Ruco L. Papillary carcinoma of the thyroid: low expression of NCAM (CD56) is associated with downregulation of VEGF‐D production by tumour cells. The Journal of pathology. 2007; 212(4):411-9.
15.Zeromski J, Biczysko M, Stajgis P, Lawniczak M, Biczysko W. CD56 (NCAM) antigen in glandular epithelium of human thyroid: light microscopic and ultrastructural study. Folia histochemica et cytobiologica/Polish Academy of Sciences, Polish Histochemical and Cytochemical Society. 1998;37 (1):11-7.
16.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.J Endocr Pathol. 2003; 14 (1):55-60.
17.Cavallaro U, Niedermeyer J, Fuxa M, Christofori G. N-CAM modulates tumour-cell adhesion to matrix by inducing FGF-receptor signalling. J Nat Cell Biol. 2001;3 (7):650-7.
18.Shin MK, Kim JW, Ju Y-S. CD56 and high molecular weight cytokeratin as diagnostic markers of papillary thyroid carcinoma. Korean Journal of Pathology. 2011;45 (5):477-84.
19. Etem H, ÖZEKİnCİ S, Mizrak B, ŞEnTüRK S. The role of CD56, HBME-1, and p63 in follicular neoplasms of the thyroid.J Turk Patoloji Derg. 2010;26(3):238-42.
20. DeLellis RA. Pathology and genetics of thyroid carcinoma. J Surg Oncol. 2006;94 (8):662-9.
21.Abdelzaher E, Rizk AM, Allam M. A Logistic Regression Model Predicting Malignancy in Follicular Thyroid Lesions Based on CD56 Expression and Patient’s Age. Journal of Interdisciplinary Histopathology. 2014; 2 (4):205-12.
22.Hoos A, Stojadinovic A, Singh B, Dudas ME, Leung DH, Shaha AR, et al. Clinical significance of molecular expression profiles of Hürthle cell tumors of the thyroid gland analyzed via tissue microarrays. The American journal of pathology. 2002;160 (1):175-83.
23.Lanier LL, Testi R, Bindl J, Phillips JH. Identity of Leu-19 (CD56) leukocyte differentiation antigen and neural cell adhesion molecule. The Journal of experimental medicine. 1989;169 (6):2233-8.
24.Zeromski J, Dworacki G, Jenek J, Niemir Z, Jezewska E, Jenek R, et al. Protein and mRNA expression of CD56/N-CAM on follicular epithelial cells of the human thyroid. Int J Immunopathol Pharmacol. 1998;12 (1):23-30.
25. Mokhtari M, Eftekhari M, Tahririan R. Absent CD56 expression in papillary thyroid carcinoma: A finding of potential diagnostic value in problematic cases of thyroid pathology. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2013;18(12):1046-9.