Expression of the sodium iodide symporter in differentiated thyroid cancer^[*]

Summary

Aim: Molecular analysis of the expression of the sodium iodide symporter (NIS) in 32 patients with differentiated thyroid cancer (DTC) and correlation with scintigraphic findings (¹³¹I,¹²³I) in 19 (59.4%) of them. Patients, methods: NIS expression of 27 primary tumours, 13 lymphnodes and 18 distant metastases was determined by immunostaining using a murine monoclonal anti-NIS-antibody. NIS expression and radionuclide uptake of metastases were analysed by a semiquantitative visual score. Patients were divided into two subgroups: Group 1 (n = 8 patients): indirect correlation of radioiodine uptake (RIU) of subsequent metastases with NIS expression of 7 primary tumours and 3 metastases; Group 2 (n=11 patients): direct correlation of radionuclide uptake with NIS expression of 19 metastases which were excised after imaging. Results: 49 of 58 specimens (84.5%) were NIS-positive. A preserved NIS-expression was found in 12 primary tumours and 8 of 10 (80%) synchrone and 6 of 7 (85.7%) metachrone metastases. Group 1 revealed a 100% positive predictive value (PPV) of a preserved NIS expression in the primary tumour regarding radioiodine uptake in metastases while a lack of NIS expression in the primary tumor did not reliable predict a loss of the metastases’ ability to concentrate radioiodine. In group 2, only 11 of 19 (57.9%) specimens showed a concordant NIS expression and RIU whereas in the remaining 8 cases without visible RIU NIS expression was still present. Conclusions: NIS expression of the primary tumour and metastases in DTC is usually well preserved. We found a positive correlation between NIS expression of the primary and metastatic tissue but could not identify such well correspondence between NIS expression and the RIU of subsequent metastases.

Zusammenfassung

Ziel: Molekulare Untersuchungen der Expression des Natriumiodid- Symporters (NIS) bei 32 Patienten mit differenziertem Schilddrüsenkarzinom und Korrelation mit szintigraphischen Befunden (¹²³I, ¹³¹I) bei 19 (59,4%) dieser Patienten. Patienten, Methoden: 27 Primärtumoren, 13 Lymphknoten- sowie 18 Organmetastasen wurden mittels eines spezifischen murinen monoklonalen anti-NIS-Antikörpers hinsichtlich ihrer NIS-Expression immunhistochemisch analysiert. Sowohl die NIS-Expression als auch der jeweilige Radionuklid-Uptake wurden anhand eines visuellen Scores semiquantitativ evaluiert. Das Patientenkollektiv wurde in zwei Gruppen unterteilt: Gruppe 1 (n = 8 Patienten): indirekte Korrelation des RIU verbliebener, immunhistochemisch nicht untersuchter Metastasen mit der NIS-Expression von 7 Primärtumoren und 3 entnommenen Metastasen; Gruppe 2 (n = 11 Patienten): Direkte Korrelation des präoperativen Uptakes von Radioiod mit der NIS-Expression von 19 entnommenen Metastasen. Ergebnisse: 49 der 58 (84,5%) Gewebeproben waren NIS-positiv. Bei 12 Primärtumoren mit NIS-Expression wiesen 8 von 10 (80%) synchronen sowie 6 von 7 (85,7%) metachronen Metastasen eine NIS-Positivität auf. In Gruppe 1 lag der positiv prädiktive Wert einer NIS-Expression im Primärtumor in Bezug auf den RIU der Metastasen bei 100%. Eine fehlende NIS-Expression im Primärtumor sagte einen Verlust an Radioiodspeicherung in Metastasen allerdings nicht zuverlässig voraus. In Gruppe 2 hatten lediglich 11 von 19 (57,9%) Metastasen eine konkordante NIS-Expression bei nachweisbarem präoperativen RIU, bei 8 NIS-positiven Präparaten blieb der RIU negativ. Schlussfolgerung: Die NIS-Expression bei differenzierten Schilddrüsenkarzinomen und ihren Metastasen ist in der Regel erhalten. Trotz einer guten Korrelation zwischen NIS-Expression des Primärtumors und seiner Metastasen, ist im Einzelfall eine zuverlässige Aussage über den RIU von Metastasen durch den Nachweis der NIS-Expression nicht möglich.

Keywords

Sodium iodide symporter - differentiated thyroid cancer - immunohistochemistry - radioiodine uptake

Schlüsselwörter

Natriumiodid-Symporter - differenziertes Schilddrüsenkarzinom - Immunhistochemie - Radioiod-Uptake

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