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Hong, Choi, and Kim: Usefulness of Thyroglobulin Measurement in Fine-needle Aspirates of Lymph Nodes for the Diagnosis of Lymph Node Metastasis of Papillary Thyroid Cancer

Abstract

Background

Previous studies have shown that thyroglobulin (Tg) measurement in fine-needle aspirates (FNA) of lymph nodes can assist in evaluating cervical lymph node metastasis. In this study, we evaluated the diagnostic performances of FNA-Tg, serum-Tg, and FNA-Tg/serum-Tg in detecting lymph node metastasis.

Methods

We retrospectively analyzed the diagnostic performances of FNA-Tg and serum-Tg in 641 cases (518 patients) with papillary thyroid cancer that underwent ultrasonography-guided fine-needle aspiration of cervical lymph nodes between March 2009 and February 2010.

Results

The number of lymph nodes and median FNA-Tg level of the positive lymph node cytology group were 99 and 1,300 ng/mL (range, 0.2-5,000), respectively, whereas corresponding values in the negative cytology group were 359 and 4.7 ng/mL (range, 0.1-1,173). The AUCs of FNA-Tg, serum-Tg, and FNA-Tg/serum-Tg ratio were 0.93 (95% CI, 0.90-0.97), 0.64 (95% CI, 0.57-0.70), and 0.83 (95% CI, 0.78-0.88), respectively. The sensitivity and specificity of FNA-Tg were 90.9% and 98.3%, respectively, and the percentage agreement with the cytology results was 96.7%.

Conclusions

The agreement of FNA-Tg with the cytology results was good at the cutoff value of 35.9 ng/mL. The measurement of FNA-Tg in cases with uninterpretable cytology results can be useful in evaluating lymph node metastasis of papillary thyroid cancer.

Figures and Tables

Fig. 1
Scatter plots of each thyroglobulin test in negative and positive fine-needle aspiration cytology groups. (A) Scatter plot of FNA-Tg in each FNA-C group, (B) Scatter plot of serum-Tg in each FNA-C group, (C) Scatter plot of FNA-Tg/serum-Tg ratio in each FNA-C group.
Abbreviations: See Table 1.
lmo-1-132-g001
Table 1
Basic characteristics and FNA-Tg and serum-Tg of study subjects (n=458)
lmo-1-132-i001

Abbreviations: FNA-C, fine-needle aspiration cytology; FNA-Tg, fine-needle aspiration thyroglobulin concentration; serum-Tg, serum thyroglobulin concentration; FNA-Tg/serum-Tg, the ratio of thyroglobulin concentration of lymph node to serum.

Table 2
Test performances of FNA-Tg, serum-Tg, and FNA-Tg/serum-Tg ratio
lmo-1-132-i002

Abbreviations: See Table 1.

Table 3
Seventeen cases with discrepant FNA-C and FNA-Tg results
lmo-1-132-i003

Abbreviations: See Table 1; CLN, cervical lymph node.

References

1. Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see commetns]. Cancer. 1998. 83:2638–2648.
2. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006. 295:2164–2167.
3. Noguchi S, Murakami N. The value of lymph-node dissection in patients with differentiated thyroid cancer. Surg Clin North Am. 1987. 67:251–261.
4. Grant CS, Hay ID, Gough IR, Bergstralh EJ, Goellner JR, McConahey WM. Local recurrence in papillary thyroid carcinoma: is extent of surgical resection important? Surgery. 1988. 104:954–962.
5. Ustün M, Risberg B, Davidson B, Berner A. Cystic change in metastatic lymph nodes: a common diagnostic pitfall in fine-needle aspiration cytology. Diagn Cytopathol. 2002. 27:387–392.
6. McDougall IR, Bayer MF. Follow-up of patients with differentiated thyroid cancer using serum thyroglobulin measured by an immunoradiometric assay. Comparison with I-131 total body scans. J Nucl Med. 1980. 21:741–744.
7. Spencer CA, Takeuchi M, Kazarosyan M, Wang CC, Guttler RB, Singer PA, et al. Serum thyroglobulin autoantibodies: prevalence, influence on serum thyroglobulin measurement, and prognostic significance in patients with differentiated thyroid carcinoma. J Clin Endocrinol Metab. 1998. 83:1121–1127.
8. Giovanella L. Highly sensitive thyroglobulin measurements in differentiated thyroid carcinoma management. Clin Chem Lab Med. 2008. 46:1067–1073.
9. Frasoldati A, Toschi E, Zini M, Flora M, Caroggio A, Dotti C, et al. Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid. 1999. 9:105–111.
10. Pacini F, Fugazzola L, Lippi F, Ceccarelli C, Centoni R, Miccoli P, et al. Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab. 1992. 74:1401–1404.
11. Cignarelli M, Ambrosi A, Marino A, Lamacchia O, Campo M, Picca G, et al. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic metastatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid. 2003. 13:1163–1167.
12. Uruno T, Miyauchi A, Shimizu K, Tomoda C, Takamura Y, Ito Y, et al. Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg. 2005. 29:483–485.
13. Cunha N, Rodrigues F, Curado F, Ilhéu O, Cruz C, Naidenov P, et al. Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: a technique for the diagnosis of metastatic differentiated thyroid cancer. Eur J Endocrinol. 2007. 157:101–107.
14. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009. 19:1167–1214.
15. Sigstad E, Heilo A, Paus E, Holgersen K, Grøholt KK, Jørgensen LH, et al. The usefulness of detecting thyroglobulin in fine-needle aspirates from patients with neck lesions using a sensitive thyroglobulin assay. Diagn Cytopathol. 2007. 35:761–767.
16. Giovanella L, Ceriani L, Suriano S, Crippa S. Thyroglobulin measurement on fine-needle washout fluids: Influence of sample collection methods. Diagn Cytopathol. 2009. 37:42–44.
17. Frasoldati A, Valcavi R. Challenges in neck ultrasonography: lymphadenopathy and parathyroid glands. Endocr Pract. 2004. 10:261–268.
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