Int J Thyroidol.  2021 May;14(1):18-27. 10.11106/ijt.2021.14.1.18.

Clinical Outcome of Fine Needle Aspiration Cytology and Washout Thyroglobulin in Suspicious Lymph Nodes in Differentiated Thyroid Carcinoma: Discordant Results in Real-World Practice

• Lee J
• Park HL
• Jo K
• Kim MH
• Bae JS
• Lee S
• Jung CK
• Jung SL
• Lim DJ

• KMID: 2516161
• DOI: http://doi.org/10.11106/ijt.2021.14.1.18

Abstract

Background and Objectives
Fine needle aspiration cytology (FNAC) combined with washout thyroglobulin (Tg) measurement is the gold standard for the evaluation of metastatic lymph nodes (LNs) in thyroid cancer. However, few studies have assessed the clinical outcomes of discordant results between FNAC and washout Tg based on surgery status and follow-up imaging in real-world practice.
Materials and Methods
A total of 707 LNs in 512 patients who underwent FNAC and washout Tg measurements from 2015 to 2017 were analyzed. The final LN outcomes were confirmed through postoperative histology, or through metastatic FNAC findings combined with high washout Tg level, follow-up imaging studies, or repeat FNA, if LNs were not dissected.
Results
The cut-off values of washout Tg for indicating LN metastasis in preoperative and postoperative LNs were 9.6 ng/mL and 2.1 ng/mL. The diagnostic accuracy was improved by applying washout Tg according to surgery status and the results of discordant rate was reduced, Discordant between results of FNAC with washout Tg and final outcome were 9.2% (27/295) of preoperative LNs and 8.7% (36/412) of postoperative LNs. Due to inconclusive results, unnecessary neck dissection can occur in 13.9% (36/259 dissected cases).
Conclusion
To improve diagnostic accuracy, cut-off values of washout Tg should be applied depending on surgery status. New biomarkers in washout fluid is necessary to resolve discordant findings.

Keyword

Thyroid neoplasms; Lymph nodes; Biopsy; Fine-needle; Thyroglobulin; Washout protein

Figure

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  Fig. 1 Final diagnosis of all LNs and of the results of FNAC and washout Tg.

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  Fig. 2 Decision making in discordant LNs between FNAC combined with wash-out Tg.

Reference

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