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KMID : 0371319930440050619
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Journal of the Korean Surgical Society
1993 Volume.44 No. 5 p.619 ~ p.630
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Relationship among DNA Ploidy, Degree of Malignancy and Prognostic Factors in Follicular Tumors of the Thyroid
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Abstract
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Distinguishing follicular adenomas(FA) from follicular carcinomas(FC's) continue to plague even experienced thyroid pathologists. DNA ploidy analysis has been prompted as means of making this differentiation. However, the finding of DNA
aneuploidy
in FA
has caused concern that they demonstrate potential for malignant behavior or should even be reclassified as low-grade noninvasive cancers. In histologically proven FC's, nuclear DNA content has been claimed to have predictive power equivalent to
that
all other prognostic factors factors combined. The aims of the present study, therefore, were to define the DNA ploidy characteristics of FA and FC's to assess the diagnostic potential of DNA content analysis, and in FC's, to investigate the
correlationship between the DNA aneuploidy and other prognostic factors.
Nuclear DNA content was measured using a novel flow cytometric method to analyze formalin-fixed paraffin-embedded tissue blocks from 50 tumors of thyroid(5 normal tissues, 5 adenomatous goiters, 20 FA's, 20 FC's). DNA aneuploidy was found in 1
(5%)
of
the 20 FA's, 6(30%) of the 20 FC's. S-phase fraction(SPF) and proliferative index(PI: SPF+C2/M) were 3.5±1.79% and 5.3±1.73% in normal thyroid tissues, 2.0±0.71% and 3.4±0.81% in the AG, 4.7±3.74% and 7.2±4.60% in the FA's, and 9.2±7.05%
and
17.2±8.14% in the FC's, respectively. Both SPF and PI in FA's were higher than in normal tissues and adenomatous goiters, and lower than those in PC's(P<0.01, P<0.01). But, there was an overlap of these two cell cycle values comparing individual
values
of FA's and FC's. Purthermore, there was no significant difference of these values between FA's and encapsulated follicular carcinomas. Among variable prognostic factors studied(age, sex, tumor size, differentiation, invasiveness, metastsis),
aneuploidy
was found to be common in the elderly(P<0.01), in the nigher stage(P<0.01), in the distant metastasis(P<0.01).
Based on these data, while not valuable for determining the presence of malignancy, DNA aneuploidy was significantly correlated to other strong prognostic factors such as age, stage, and distant metastasis. This finding suggests that DNA
aneuploidy
is
strongly correlated to the poor prognosis. Follow-up study of survival will be needed to determine the independent prognostic role of DNA aneuploidy in the FC's of the thyroid.
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KEYWORD
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