Yonsei Med J.  2012 Jan;53(1):126-131. 10.3349/ymj.2012.53.1.126.

Diagnostic Performance of Thyroglobulin Value in Indeterminate Range in Fine Needle Aspiration Washout Fluid from Lymph Nodes of Thyroid Cancer

• Sohn YM
• Kim MJ
• Kim EK
• Kwak JY

• KMID: 1779696
• DOI: http://doi.org/10.3349/ymj.2012.53.1.126

Abstract

PURPOSE
The purpose was to compare the frequency of metastatic and nonmetastatic lymph nodes diagnosed by fine needle aspiration biopsy cytology (FNAC) and thyroglobulin concentration from fine needle aspiration biopsy washout fluid (FNAB-Tg) in an indeterminate range (0.2-100 ng/mL), and to evaluate the most appropriate threshold value of FNAB-Tg in an indeterminate range.
MATERIALS AND METHODS
We performed ultrasound-guided FNAB and FNAB-Tg in suspicious metastatic cervical lymph nodes of papillary thyroid carcinoma and performed surgery. Ninety-five lymph nodes with indeterminate values of FNAB-Tg ranging from 0.2-100 ng/mL in ninety-two patients were included in this study. The diagnostic performances in multiple Tg levels (0.7, 1.0, 5.0, 10.0, 20.0, 50.0) were evaluated to compare with FNAB cytology using sensitivity, specificity, and accuracy with area under the curve (AUC) analysis.
RESULTS
Forty-two were metastatic lymph nodes and fifty three were nonmetastatic lymph nodes. FNAB-Tg ranged from 0.22 to 90.9 ng/mL in metastatic lymph nodes (mean; 34.3+/-33.3 ng/mL) and 0.20 to 56.7 ng/mL in nonmetastatic lymph nodes (mean; 4.9+/-11.1 ng/mL) (p<0.001). The most excellent diagnostic performance was displayed in 5 ng/mL of FNAB-Tg with AUC of 0.76, sensitivity, specificity, accuracy, 69.0, 83.0, and 76.8, respectively. However, there was no significant difference from 10 ng/mL FNAB.
CONCLUSION
We ascertained that 5 ng/mL yielded the most excellent diagnostic performance among FNAB-Tg levels in the present setting with a large series with the indeterminate range (0.2-100 ng/mL) of FNAB-Tg values. These results need additional confirmation under different laboratory conditions.

Keyword

Fine needle aspiration biopsy; thyroglobulin; lymph nodes

MeSH Terms

Biopsy, Fine-Needle/*methods/standards/statistics & numerical data
Body Fluids/metabolism
Carcinoma, Papillary/*metabolism/*secondary/ultrasonography
Humans
Lymph Nodes/metabolism/pathology/ultrasonography
Lymphatic Metastasis
Retrospective Studies
Sensitivity and Specificity
Thyroglobulin/*metabolism
Thyroid Neoplasms/*metabolism/*secondary/ultrasonography
Ultrasonography, Interventional

Figure

• 

  Fig. 1 Thyroglobulin concentration from fine needle aspiration biopsy washout fluid (FNAB-Tg) and final diagnosis. (A) The distribution of FNAB-Tg values is displayed according to the final diagnosis of 95 lymph nodes. The mean value of FNAB-Tg is 35.09 ng/mL in metastatic lymph nodes and 4.87 ng/mL in nonmetastatic lymph nodes. (B) Receiver operator characteristics for FNAB-Tg in this study. The area under the curve is 0.799 (95% confidence interval 0.7063-0.8949).

Reference

1. Boland GW, Lee MJ, Mueller PR, Mayo-Smith W, Dawson SL, Simeone JF. Efficacy of sonographically guided biopsy of thyroid masses and cervical lymph nodes. AJR Am J Roentgenol. 1993. 161:1053–1056.

2. Jeon SJ, Kim E, Park JS, Son KR, Baek JH, Kim YS, et al. Diagnostic benefit of thyroglobulin measurement in fine-needle aspiration for diagnosing metastatic cervical lymph nodes from papillary thyroid cancer: correlations with US features. Korean J Radiol. 2009. 10:106–111.

3. Kim MJ, Kim EK, Kim BM, Kwak JY, Lee EJ, Park CS, et al. Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer. Clin Endocrinol (Oxf). 2009. 70:145–151.

4. Takashima S, Sone S, Nomura N, Tomiyama N, Kobayashi T, Nakamura H. Nonpalpable lymph nodes of the neck: assessment with US and US-guided fine-needle aspiration biopsy. J Clin Ultrasound. 1997. 25:283–292.

5. Lee MJ, Ross DS, Mueller PR, Daniels GH, Dawson SL, Simeone JF. Fine-needle biopsy of cervical lymph nodes in patients with thyroid cancer: a prospective comparison of cytopathologic and tissue marker analysis. Radiology. 1993. 187:851–854.

6. Snozek CL, Chambers EP, Reading CC, Sebo TJ, Sistrunk JW, Singh RJ, et al. Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin Endocrinol Metab. 2007. 92:4278–4281.

7. 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.

8. Sigstad E, Heilo A, Paus E, Holgersen K, Grøholt KK, Jrgensen 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.

9. Baloch ZW, Barroeta JE, Walsh J, Gupta PK, Livolsi VA, Langer JE, et al. Utility of Thyroglobulin measurement in fine-needle aspiration biopsy specimens of lymph nodes in the diagnosis of recurrent thyroid carcinoma. Cytojournal. 2008. 5:1.

10. Baskin HJ. Detection of recurrent papillary thyroid carcinoma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid. 2004. 14:959–963.

11. Boi F, Baghino G, Atzeni F, Lai ML, Faa G, Mariotti S. The diagnostic value for differentiated thyroid carcinoma metastases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies. J Clin Endocrinol Metab. 2006. 91:1364–1369.

12. 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.

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. 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.

15. Lima N, Cavaliere H, Tomimori E, Knobel M, Medeiros-Neto G. Prognostic value of serial serum thyroglobulin determinations after total thyroidectomy for differentiated thyroid cancer. J Endocrinol Invest. 2002. 25:110–115.

16. 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.

17. Borel AL, Boizel R, Faure P, Barbe G, Boutonnat J, Sturm N, et al. Significance of low levels of thyroglobulin in fine needle aspirates from cervical lymph nodes of patients with a history of differentiated thyroid cancer. Eur J Endocrinol. 2008. 158:691–698.

18. Bruno R, Giannasio P, Chiarella R, Capula C, Russo D, Filetti S, et al. Identification of a neck lump as a lymph node metastasis from an occult contralateral papillary microcarcinoma of the thyroid: key role of thyroglobulin assay in the fine-needle aspirate. Thyroid. 2009. 19:531–533.

19. Miseikyte-Kaubriene E, Trakymas M, Ulys A. Cystic lymph node metastasis in papillary thyroid carcinoma. Medicina (Kaunas). 2008. 44:455–459.

20. Fish SA, Langer JE, Mandel SJ. Sonographic imaging of thyroid nodules and cervical lymph nodes. Endocrinol Metab Clin North Am. 2008. 37:401–417.

21. Kuna SK, Bracic I, Tesic V, Kuna K, Herceg GH, Dodig D. Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer. J Ultrasound Med. 2006. 25:1531–1537.

22. Park JS, Son KR, Na DG, Kim E, Kim S. Performance of preoperative sonographic staging of papillary thyroid carcinoma based on the sixth edition of the AJCC/UICC TNM classification system. AJR Am J Roentgenol. 2009. 192:66–72.

23. Rosário PW, de Faria S, Bicalho L, Alves MF, Borges MA, Purisch S, et al. Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J Ultrasound Med. 2005. 24:1385–1389.

24. Lee MJ, Hong SW, Chung WY, Kwak JY, Kim MJ, Kim EK. Cytological results of ultrasound-guided fine-needle aspiration cytology for thyroid nodules: emphasis on correlation with sonographic findings. Yonsei Med J. 2011. 52:838–844.

25. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988. 44:837–845.