J Korean Med Sci.  2012 Sep;27(9):1014-1018. 10.3346/jkms.2012.27.9.1014.

Preoperative Serum Thyroglobulin as a Useful Predictive Marker to Differentiate Follicular Thyroid Cancer from Benign Nodules in Indeterminate Nodules

• Lee EK
• Chung KW
• Min HS
• Kim TS
• Kim TH
• Ryu JS
• Jung YS
• Kim SK
• Lee YJ

• KMID: 1782133
• DOI: http://doi.org/10.3346/jkms.2012.27.9.1014

Abstract

Indeterminate cytology results increase the number of repetitive procedure and unnecessary surgery. This study was designed to find useful and simple predictive tools to differentiate malignant thyroid nodules from indeterminate nodules. We retrospectively enrolled 164 patients who had undergone thyroid surgery as a result of indeterminate cytology in the National Cancer Center. We reviewed patients' age at diagnosis, sex, preoperative biochemical markers such as thyroglobulin (Tg), anti-Tg antibody, free T4 and TSH level, and sonographical and pathological findings, which were subjected to statistical analysis. We found several clinical and sonographical predictive factors that showed significant differences. Young age, male, preoperative high Tg level, and hypoechoic nodule on sonography all increased cancer probability significantly in multivariate analysis. With a cut-off value of 187.5 ng/mL Tg, sensitivity and specificity were 54.8% and 90.1%, respectively (AUC 0.748, P < 0.001). In the case of nodule size > 1.7 cm, elevated serum Tg predicts the risk of malignancy; especially Tg > 70 ng/mL (odds ratio 3.245, 95% confidence interval 1.115-9.450, P = 0.038). Preoperative Tg levels had very high specificity in predicting thyroid cancer in case of suspicious follicular neoplasm. Therefore, Tg levels may be a useful marker for differentiating thyroid cancer from benign thyroid nodules in the cytological diagnosis of indeterminate nodules.

Keyword

Thyroid Nodule; Fine Needle Aspiration; Thyroglobulin

MeSH Terms

Adenocarcinoma, Follicular/*diagnosis/metabolism/pathology
Adult
Age Factors
Aged
Autoantibodies/blood
Biological Markers/blood
Female
Humans
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
ROC Curve
Retrospective Studies
Sensitivity and Specificity
Sex Factors
Thyroglobulin/*blood
Thyroid Nodule/ultrasonography
Autoantibodies
Biological Markers
Thyroglobulin

Figure

• 

  Fig. 1 Patients enrolled in our study. Indeterminate cytology included all of "atypical of undetermined significance or follicular lesion of undetermined significance" and "follicular neoplasm or suspicious for a follicular neoplasm." MIFTC, minimally invasive follicular thyroid carcinoma; WIFTC, widely invasive follicular thyroid carcinoma.

• 

  Fig. 2 ROC curve of Tg levels to predict malignancy in indeterminate nodules.

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