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Abstract
Purpose
The aim of this study was to evaluate added value and diagnostic threshold value of thyroglobulin measurement in the fine-needle aspiration washout for detecting cervical lymph node metastasis from papillary thyroid cancer on pre and postoperative patients.
Materials and Methods
Total 219 cervical lymph nodes from 180 patients with papillary thyroid cancer were evaluated for fine needle aspiration cytology and thyroglobulin in fine needle aspiration (FNA-Tg), using immunometric chemiluminescent assay. Eighty-six patients were preoperative and remaining 94 patients were on follow up after total thyroidectomy. Final diagnoses were made on pathology of dissected lymph nodes or follow-up examination for at least 12 months.
Results
One hundred and twelve metastatic lymph nodes were finally confirmed in 94 patients out of total 180 patients. Sensitivity of FNA-Tg was 99.1, 98.21, 97.20%, respectively with threshold level at 1, 10, serum Tgng/mL, which were higher sensitivity of fine needle aspiration. Combined FNA and FNA-Tg with threshold at 1, 10, 100 ng/mL raised sensitivity and specificity to 100%, respectively. All 6 lymph nodes that were false negative on FNA were correctly diagnosed as metastasis on FNA-Tg with threshold of 1, 10, 100, and serum thyroglobulin. FNA-Tg with threshold level at 100 ng/mL combined FNA showed highest sensitivity (100%) and specificity (97.56%) on preoperative patient groups among the 1, 10, 100, serum Tg threshold value. But, FNA only showed adequately high sensitivity (100%) and specificity (96.96%) on postoperative patient groups. Using receiver operating characteristic curve (ROC) curve analysis, cut off value was 57.69 in total patient, 78.66 in preoperative patient, and 32.81 in postoperative patient.
Conclusion
FNA-Tg combined with FNA showed excellent sensitivity and specificity. FNA-Tg showed very high sensitivity and specificity at threshold level 78.66 ng/mL in preoperative patients, but FNA-Tg had less benefit on the postoperative patient group, having high sensitivity and specificity with FNA alone.
Figures and Tables
Fig. 1
Metastatic cystic cervical lymph node. Preoperative ultrasound in a 38-year-old man shows a 1.3 cm sized solid and calcified nodule in right thyroid and 3.3 cm cystic lymph node (caliber) at the level IV of the left neck. Ultrasound guided fine needle aspiration cytology reveals atypical cells; but the value of thyroglobulin in the fine needle aspiration washout is 132 ng/mL. The thyroid nodule is confirmed as papillary thyroid cancer and lymph node is confirmed pathologically as metastatic lymph node on thyroidectomy and lymph node dissection.
Fig. 2
Metastatic microcalcified cervical lymph node. Preoperative ultrasound in a 24-year-old woman shows a 2 cm sized microcalcified nodule in right thyroid and 0.7 cm microcalcified lymph node (caliber) at the level 3 of the right neck. Ultrasound guided fine needle aspiration cytology reveals inadequate specimen; but the value of thyroglobulin in the fine needle aspiration washout is 203 ng/mL. The thyroid nodule is confirmed as papillary thyroid cancer and lymphnode is confirmed pathologically as metastatic lymph node at thyroidectomy and lymph node dissection.
Fig. 3
The values of FNA-Tg wash-out of metastatic lymph nodes (group1) and non-metastatic lymph nodes (group 2).
FNA-Tg = thyroglobulin in fine needle aspiration
Fig. 4
The values of FNA-Tg wash-out/serum thyroglobulin in metastatic lymph nodes and benign lymph nodes.
FNA-Tg = thyroglobulin in fine needle aspiration
Fig. 5
The value of FNA-Tg wash-out of metastatic lymph nodes in preoperative metastatic lymph nodes and postoperative metastatic lymph nodes.
FNA-Tg = thyroglobulin in fine needle aspiration
Fig. 6
The value of serum thyroglobulin (Tg) in preoperative metastatic lymph nodes and postoperative metastatic lymph nodes.
Fig. 7
Receiver operator characteristics for FNA-Tg in this study.
A. Receiver operator characteristics for FNA-Tg in the total patient cohort of this study. The area under the curve is 0.988.
B. Receiver operator characteristics for FNA-Tg in this study in preoperative patients. The area under the curve is 0.988.
C. Receiver operator characteristics for FNA-Tg in this study in post-operative patients. The area under the curve is 0.988.
FNA-Tg = thyroglobulin in fine needle aspiration
Table 1
Sensitivity and Specificity of FNAC Versus FNA-Tg with Different Threshold
Table 2
Sensitivity and Specificity of FNA Versus Combined FNAC and FNA-Tg with Different Threshold
Table 3
Sensitivity and Specificity of FNA Versus FNA-Tg with Different Threshold on Pre-Operative and Post-Operative Groups
Table 4
Sensitivity and Specificity of FNA Versus Combined FNAC and FNA-Tg with Different Threshold on Pre-Operative and Post-Operative Groups
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