Yonsei Med J.  2015 Jan;56(1):182-188. 10.3349/ymj.2015.56.1.182.

Overcoming the Limitations of Fine Needle Aspiration Biopsy: Detection of Lateral Neck Node Metastasis in Papillary Thyroid Carcinoma

• Jun HH
• Kim SM
• Kim BW
• Lee YS
• Chang HS
• Park CS

• KMID: 2352805
• DOI: http://doi.org/10.3349/ymj.2015.56.1.182

Abstract

PURPOSE
Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer.
MATERIALS AND METHODS
FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared.
RESULTS
Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients, the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age <45 years (p=0.006), tumor size >1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003).
CONCLUSION
To reduce the false negative rate of FNAB, patient age (<45 years), tumor size (>1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.

Keyword

Papillary thyroid carcinoma; metastasis

MeSH Terms

Adolescent
Adult
Aged
Biopsy, Fine-Needle
Carcinoma/*diagnosis/*pathology/radiography/surgery
False Negative Reactions
Female
Humans
Lymph Nodes/*pathology/radiography
Lymphatic Metastasis/*pathology/radiography
Male
Middle Aged
Multivariate Analysis
Preoperative Care
Risk Factors
Sensitivity and Specificity
Thyroglobulin/metabolism
Thyroid Gland/*pathology
Thyroid Neoplasms/*diagnosis/*pathology/radiography/surgery
Tomography, X-Ray Computed
Young Adult
Thyroglobulin

Figure

• 

  Fig. 1 Diagram of the algorithm for evaluation and management of lateral neck node. FNAB, fine needle aspiration biopsy; US, ultrasound; FNA, fine needle aspiration; Tg, thyroglobulin; HU, Hounsfield unit.

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