Lab Med Online.  2011 Jul;1(3):132-137.

Usefulness of Thyroglobulin Measurement in Fine-needle Aspirates of Lymph Nodes for the Diagnosis of Lymph Node Metastasis of Papillary Thyroid Cancer

Affiliations
  • 1Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea. SYKIM@yuhs.ac

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.

Keyword

Thyroid cancer; Thyroglobulin; Lymph node; Fine-needle aspiration

MeSH Terms

Area Under Curve
Biopsy, Fine-Needle
Lymph Nodes
Neoplasm Metastasis
Retrospective Studies
Sensitivity and Specificity
Thyroglobulin
Thyroid Gland
Thyroid Neoplasms
Thyroglobulin

Figure

  • 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.


Reference

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.
Article
2. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006. 295:2164–2167.
Article
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.
Article
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.
Article
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.
Article
8. Giovanella L. Highly sensitive thyroglobulin measurements in differentiated thyroid carcinoma management. Clin Chem Lab Med. 2008. 46:1067–1073.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
17. Frasoldati A, Valcavi R. Challenges in neck ultrasonography: lymphadenopathy and parathyroid glands. Endocr Pract. 2004. 10:261–268.
Article
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