Utilizing Immunoglobulin G4 Immunohistochemistry for Risk Stratification in Patients with Papillary Thyroid Carcinoma Associated with Hashimoto Thyroiditis.

Publisher: Korean Endocrine Society Country of Publication: Korea (South) NLM ID: 101554139 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2093-5978 (Electronic) Linking ISSN: 2093596X NLM ISO Abbreviation: Endocrinol Metab (Seoul) Subsets: MEDLINE

Original Publication: Seoul : Korean Endocrine Society, [2010]-

Hashimoto Disease*/pathology ; Hashimoto Disease*/immunology ; Immunoglobulin G* ; Thyroid Cancer, Papillary*/pathology ; Thyroid Cancer, Papillary*/surgery ; Thyroid Cancer, Papillary*/immunology ; Thyroid Neoplasms*/pathology ; Thyroid Neoplasms*/immunology ; Thyroid Neoplasms*/surgery ; Thyroid Neoplasms*/diagnosis ; Immunohistochemistry*/methods; Humans ; Male ; Female ; Middle Aged ; Cross-Sectional Studies ; Adult ; Risk Assessment ; Thyroidectomy ; Aged ; Neoplasm Recurrence, Local/pathology ; Prognosis

Backgruound: Hashimoto thyroiditis (HT) is suspected to correlate with papillary thyroid carcinoma (PTC) development. While some HT cases exhibit histologic features of immunoglobulin G4 (IgG4)-related disease, the relationship of HT with PTC progression remains unestablished.
Methods: This cross-sectional study included 426 adult patients with PTC (≥1 cm) undergoing thyroidectomy at an academic thyroid center. HT was identified based on its typical histologic features. IgG4 and IgG immunohistochemistry were performed. Wholeslide images of immunostained slides were digitalized. Positive plasma cells per 2 mm2 were counted using QuPath and a pre-trained deep learning model. The primary outcome was tumor structural recurrence post-surgery.
Results: Among the 426 PTC patients, 79 were diagnosed with HT. With a 40% IgG4 positive/IgG plasma cell ratio as the threshold for diagnosing IgG4-related disease, a cutoff value of >150 IgG4 positive plasma cells per 2 mm2 was established. According to this criterion, 53% (43/79) of HT patients were classified as IgG4-related. The IgG4-related HT subgroup presented a more advanced cancer stage than the IgG4-non-related HT group (P=0.038). The median observation period was 109 months (range, 6 to 142). Initial assessment revealed 43 recurrence cases. Recurrence-free survival periods showed significant (P=0.023) differences, with patients with IgG4 non-related HT showing the longest period, followed by patients without HT and those with IgG4-related HT.
Conclusion: This study effectively stratified recurrence risk in PTC patients based on HT status and IgG4-related subtypes. These findings may contribute to better-informed treatment decisions and patient care strategies.

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HI21C0940 Ministry of Health and Welfare; Ministry of Science and ICT; Ministry of Trade, Industry and Energy; RS-2023-00243633 Ministry of Food and Drug Safety

Keywords: Cross-sectional studies; Deep learning; Hashimoto disease; Immunoglobulin G4-related disease; Immunohistochemistry; Thyroid cancer, papillary; Thyroid neoplasms

0 (Immunoglobulin G)

Date Created: 20240520 Date Completed: 20240628 Latest Revision: 20240705

20240705

PMC11220220

10.3803/EnM.2024.1923

38766717