Evaluation of Lipocalin-2 and Twist expression in thyroid cancers and its relationship with epithelial mesenchymal transition.

ABSTRACT

OBJECTIVE: To evaluate the expressions of lipocalin-2 (LCN-2) and Twist in thyroid cancers and examine its relationship with epithelial-to-mesenchymal transition (EMT) and clinicopathological factors. MATERIALS AND METHODS: The expression of LCN-2 and Twist was immunohistochemically evaluated in a total of 249 cases, including 120 patients with papillary thyroid carcinomas (PTC), 34 with follicular thyroid carcinoma (FTC), 15 with medullary thyroid carcinomas (MTC), 20 with non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), 47 with follicular adenomas (FA), and 13 with nodular hyperplasia (NH). In addition, the relationship between the expression of EMT markers E-cadherin and vimentin was investigated in malignant cases. RESULTS: A significant increase was observed in the LCN-2 and Twist expression from NH and FA to NIFTP, MTC, FTC, and PTC (p = 0.001). A high degree of LCN-2 expression was observed in the aggressive variants of PTC (p = 0.002). Twisthigh positivity was significantly higher in cases with the EMT-positive mesenchymal phenotype (p = 0.036). CONCLUSIONS: LCN-2 and Twist can be helpful diagnostic markers in the differentiation of benign and malignant thyroid nodules. Twisthigh expression supports the EMT process in thyroid cancer. LCN-2 and Twist expression may also serve as valuable predictive biomarkers in patients with thyroid cancer. In future, the determination of a LCN-2high expression in the aggressive variants of PTC may be integrated into targeted treatment strategies.