Journal List > J Korean Soc Radiol > v.75(5) > 1087729

Yun, Lee, and Park: Added Value of Thyroglobulin Measurement in the Fine-Needle Aspiration Washout to Diagnose Cervical Metastatic Lymphadenopathy from Papillary Thyroid Cancer

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.

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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.

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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
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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
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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
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Fig. 6

The value of serum thyroglobulin (Tg) in preoperative metastatic lymph nodes and postoperative metastatic lymph nodes.

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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
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Table 1

Sensitivity and Specificity of FNAC Versus FNA-Tg with Different Threshold

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Sensitivity p-Value Specificity p-Value PPV p-Value NPV p-Value Accuracy p-Value
FNAC 94.64% (106/112) 98.13% (105/107) 98.15% (106/108) 94.59% (105/111) 96.35% (211/219) 0.289
FNA-Tg (1) 99.11% (111/112) 0.125 67.29% (72/107) < 0.001 76.03% (111/146) < 0.001 98.63% (72/73) 0.155 83.56% (183/219) < 0.001
FNA-Tg (10) 98.21% (110/112) 0.289 83.18% (89/107) < 0.001 85.94% (110/128) < 0.001 97.80% (89/91) 0.236 90.87% (199/219) < 0.001
FNA-Tg (100) 88.39% (99/112) 0.167 99.07% (106/107) 1.000 99.00% (99/100) 0.604 89.08% (106/119) 0.113 93.61% (205/219) 0.003
FNA-Tg (serum-Tg) 97.20% (104/107) 0.453 73.83% (79/107) < 0.001 78.79% (104/132) < 0.001 96.34% (79/82) 0.511 85.51% (183/214) < 0.001

FNAC = fine needle aspiration cytology, FNA-Tg = thyroglobulin in fine needle aspiration, NPV = negative predictive value, PPV = positive predictive value

Table 2

Sensitivity and Specificity of FNA Versus Combined FNAC and FNA-Tg with Different Threshold

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Sensitivity p-Value Specificity p-Value PPV p-Value NPV p-Value Accuracy p-Value
FNAC 94.64% (106/112) 98.13% (105/107) 98.15% (106/108) 94.59% (105/111) 96.35% (211/219) 0.289
FNAC + FNA-Tg (1) 100.00% (112/112) 0.031 65.42% (70/107) < 0.001 75.17% (112/149) < 0.001 100.00% (70/70) 0.045 83.11% (182/219) < 0.001
FNAC + FNA-Tg (10) 100.00% (112/112) 0.031 81.31% (87/107) < 0.001 84.85% (112/132) < 0.001 100.00% (87/87) 0.026 90.87% (199/219) < 0.001
FNAC + FNA-Tg (100) 100.00% (112/112) 0.031 97.20% (104/107) 1.000 97.39% (112/115) 0.389 100.00% (104/104) 0.015 98.63% (216/219) 0.248
FNAC + FNA-Tg (serum-Tg) 99.07% (106/107) 0.062 72.90% (78/107) < 0.001 78.52% (106/135) < 0.001 98.73% (78/79) 0.073 85.98% (184/214) < 0.001

FNAC = fine needle aspiration cytology, FNA-Tg = thyroglobulin in fine needle aspiration, NPV = negative predictive value, PPV = positive predictive value

Table 3

Sensitivity and Specificity of FNA Versus FNA-Tg with Different Threshold on Pre-Operative and Post-Operative Groups

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Sensitivity p-Value Specificity p-Value PPV p-Value NPV p-Value Accuracy p-Value
Pre-operative
 FNAC 90.00% (54/60) 100.00% (41/41) 100.00% (54/54) 87.23% (41/47) 94.06% (95/101) 0.041
 FNA-Tg (1) 100.00% (60/60) 0.031 63.41% (26/41) < 0.001 80.00% (60/75) < 0.001 100.00% (26/26) 0.049 85.15% (86/101) < 0.001
 FNA-Tg (10) 100.00% (60/60) 0.031 80.49% (33/41) 0.008 88.24% (60/68) 0.007 100.00% (33/33) 0.027 92.08% (93/101) 0.013
 FNA-Tg (100) 90.00% (54/60) 1.000 97.56% (40/41) 1.000 98.18% (54/55) 0.318 86.96% (40/46) 0.966 93.07% (94/101) 0.131
 FNA-Tg (serum-Tg) 94.55% (52/55) 0.453 82.93% (34/41) 0.016 88.14% (52/59) 0.010 91.89% (34/37) 0.414 89.58% (86/96) 0.343
Post-operative
 FNAC 100.00% (52/52) 96.97% (64/66) 96.30% (52/54) 100.00% (64/64) 98.31% (116/118) 0.480
 FNA-Tg (1) 98.08% (51/52) 1.000 69.70% (46/66) < 0.001 71.83% (51/71) < 0.001 97.87% (46/47) 0.239 82.20% (97/118) < 0.001
 FNA-Tg (10) 96.15% (50/52) 0.500 84.85% (56/66) 0.039 83.33% (50/60) 0.017 96.55% (56/58) 0.131 89.83% (106/118) 0.043
 FNA-Tg (100) 86.54% (45/52) 0.016 100.00% (66/66) 0.500 100.00% (45/45) 0.188 90.41% (66/73) 0.009 94.07% (111/118) 0.023
 FNA-Tg (serum-Tg) 100.00% (52/52) < 0.001 68.18% (45/66) < 0.001 71.23% (52/73) < 0.001 100.00% (45/45) 1.000 82.20% (97/118) < 0.001

FNAC = fine needle aspiration cytology, FNA-Tg = thyroglobulin in fine needle aspiration, NPV = negative predictive value, PPV = positive predictive value

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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Sensitivity p-Value Specificity p-Value PPV p-Value NPV p-Value Accuracy p-Value
Pre-operative
 FNAC 90.00% (54/60) 100.00% (41/41) 100.00% (54/54) 87.23% (41/47) 94.06% (95/101) 0.041
 FNAC + FNA-Tg (1) 100.00% (60/60) 0.031 63.41% (26/41) < 0.001 80.00% (60/75) < 0.001 100.00% (26/26) 0.049 85.15% (86/101) < 0.001
 FNAC + FNA-Tg (10) 100.00% (60/60) 0.031 80.49% (33/41) 0.008 88.24% (60/68) 0.007 100.00% (33/33) 0.027 92.08% (93/101) 0.013
 FNAC + FNA-Tg (100) 100.00% (60/60) 0.031 97.56% (40/41) 1.000 98.36% (60/61) 0.343 100.00% (40/40) 0.015 99.01% (100/101) 1.000
 FNAC + FNA-Tg (serum-Tg) 98.18% (54/55) 0.062 82.93% (34/41) 0.016 88.52% (54/61) 0.011 97.14% (34/35) 0.051 91.67% (88/96) 0.077
Post-operative
 FNAC 100.00% (52/52) 96.97% (64/66) 96.30% (52/54) 100.00% (64/64) 98.31% (116/118) 0.480
 FNAC + FNA-Tg (1) 100.00% (52/52) < 0.001 66.67% (44/66) < 0.001 70.27% (52/74) < 0.001 100.00% (44/44) 1.000 81.36% (96/118) < 0.001
 FNAC + FNA-Tg (10) 100.00% (52/52) < 0.001 81.82% (54/66) 0.002 81.25% (52/64) 0.002 100.00% (54/54) 1.000 89.83% (106/118) 0.001
 FNAC + FNA-Tg (100) 100.00% (52/52) < 0.001 96.97% (64/66) < 0.001 96.30% (52/54) 1.000 100.00% (64/64) 1.000 98.31% (116/118) 0.480
 FNAC + FNA-Tg (serum-Tg) 100.00% (52/52) < 0.001 66.67% (44/66) < 0.001 70.27% (52/74) < 0.001 100.00% (44/44) 1.000 81.36% (96/118) < 0.001

FNAC = fine needle aspiration cytology, FNA-Tg = thyroglobulin in fine needle aspiration, NPV = negative predictive value, PPV = positive predictive value

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