Extensive lymphatic spread of papillary thyroid microcarcinoma is associated with an increase in expression of genes involved in epithelial‐mesenchymal transition and cancer stem cell‐like properties

BACKGROUND: Active surveillance is an alternative management for patents with low‐risk papillary thyroid microcarcinoma (PTMC); however, there is an absence of specific molecular markers that predict its progression. We compared gene expression patterns between PTMC with lateral neck‐node metastasis (N1b) and PTMC‐lacking nodal metastasis (N0). METHODS: We performed oligonucleotide microarray analysis in three PTMCs without cervical lymph‐node metastases (N0), and five PTMCs with lateral neck‐node metastasis (N1b) at initial diagnosis, using an Illumina HumanHT‐12 v4.0 Expression BeadChip. Quantitative real‐time PCR (qPCR) and western blot analysis confirmed microarray data. We performed immunohistochemistry (IHC) to confirm protein overexpression in samples from 20 N0 and 24 N1b PTMC patients who underwent thyroidectomy. RESULTS: Microarray analyses identified 52 probes corresponding to 45 genes. Expression of these genes differed significantly between the two PTMC groups. Forty genes were significantly upregulated and five genes were downregulated in N1b PTMC compared to N0. Four genes related to epithelial‐to‐mesenchymal transition (EMT) and stem cell markers, including ALDH1A3, TM4SF1, PROM1, and CAV1 were significantly upregulated in N1b PTMCs. Real‐time qPCR confirmed this expression and western blot analysis confirmed higher expression of ALDH1A3, TM4SF1, PROM1, and CAV1 in N1b than in N0 PTMCs. IHC indicated overexpression of ALDH1A3 and CAV1 in N1b compared to N0 PTMCs. CONCLUSIONS: Genes related to EMT and thyroid cancer stem cell‐like properties are upregulated in early extensive lymphatic spread of PTMC.