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Thyroglobulin measurements in washouts of fine-needle aspiration biopsy in the monitoring of patients with differentiated thyroid carcinoma
Affiliations- Department of Pathology, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland
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Abstract
Introduction: Approximately 35% patients with papillary thyroid carcinoma (PTC) and 13% with follicular thyroid carcinoma (FTC) present with metastases of cervical lymph nodes (LNs) at the time of diagnosis. In addition, 15–20% of patients treated with total thyroidectomy develop, after an interval of five years, metastases to the neck LNs on ultrasound examination. Fine-needle aspiration biopsy (FNAB) represents the gold standard technique for the detection of cervical LNs metastases. The aim of the study was to evaluate the diagnostic performance of the technique of thyroglobulin (Tg) measurement of washout FNAB (FNAB-Tg) in diagnostics of LNs metastases in different groups of patients with differentiated thyroid carcinoma (DTC).
Material and methods: Two hundred FNAB-Tg samples from 200 patients [158 women; 42 men; mean age 51.37 ± 16.77 (53)] diagnosed with DTC were examined for the assessment of the diagnostic utility of FNAB-Tg from suspicious LNs. FNAB-Tg ranged from 1.96 to 5000 ng/mL in metastatic LNs [mean; 1510 ± 1486 ng/mL (958.5)] and from 0.04 to 635.9 ng/mL in nonmetastatic LNs [mean; 57.86 ± 319.19 ng/mL (1.96)], p < 0.001.
Results: The most accurate diagnostic performance was displayed for the concentration of 33.28 ng/mL in FNAB-Tg with AUC of 0.91 and high sensitivity and specificity (0.92 and 0.93). FNAB-Tg in conjunction with the cytopathological examination of suspicious LNs in differentiated thyroid carcinoma (DTC) patients increases the diagnostic accuracy of FNAB (sensitivity 0.99; specificity 0.99; AUC 1.00).
Conclusions: FNAB-Tg may be particularly useful in detecting LN metastases in DTC patients, and in differential diagnosis of various LN metastasizing malignancies. The combination of FNAB and FNAB-Tg measurement has high specificity and sensitivity in the detection of LN metastases of DTC.
Abstract
Introduction: Approximately 35% patients with papillary thyroid carcinoma (PTC) and 13% with follicular thyroid carcinoma (FTC) present with metastases of cervical lymph nodes (LNs) at the time of diagnosis. In addition, 15–20% of patients treated with total thyroidectomy develop, after an interval of five years, metastases to the neck LNs on ultrasound examination. Fine-needle aspiration biopsy (FNAB) represents the gold standard technique for the detection of cervical LNs metastases. The aim of the study was to evaluate the diagnostic performance of the technique of thyroglobulin (Tg) measurement of washout FNAB (FNAB-Tg) in diagnostics of LNs metastases in different groups of patients with differentiated thyroid carcinoma (DTC).
Material and methods: Two hundred FNAB-Tg samples from 200 patients [158 women; 42 men; mean age 51.37 ± 16.77 (53)] diagnosed with DTC were examined for the assessment of the diagnostic utility of FNAB-Tg from suspicious LNs. FNAB-Tg ranged from 1.96 to 5000 ng/mL in metastatic LNs [mean; 1510 ± 1486 ng/mL (958.5)] and from 0.04 to 635.9 ng/mL in nonmetastatic LNs [mean; 57.86 ± 319.19 ng/mL (1.96)], p < 0.001.
Results: The most accurate diagnostic performance was displayed for the concentration of 33.28 ng/mL in FNAB-Tg with AUC of 0.91 and high sensitivity and specificity (0.92 and 0.93). FNAB-Tg in conjunction with the cytopathological examination of suspicious LNs in differentiated thyroid carcinoma (DTC) patients increases the diagnostic accuracy of FNAB (sensitivity 0.99; specificity 0.99; AUC 1.00).
Conclusions: FNAB-Tg may be particularly useful in detecting LN metastases in DTC patients, and in differential diagnosis of various LN metastasizing malignancies. The combination of FNAB and FNAB-Tg measurement has high specificity and sensitivity in the detection of LN metastases of DTC.
Keywords
thyroid carcinoma; thyroglobulin; fine-needle aspiration biopsy; lymph node metastasis; washout of the needle
About this articleTitle
Thyroglobulin measurements in washouts of fine-needle aspiration biopsy in the monitoring of patients with differentiated thyroid carcinoma
Journal
Issue
Article type
Original paper
Pages
601-608
Published online
2021-08-16
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6481
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518
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2021;72(6):601-608.
Keywords
thyroid carcinoma
thyroglobulin
fine-needle aspiration biopsy
lymph node metastasis
washout of the needle
Authors
Elwira Bakuła-Zalewska
Agnieszka Żyłka
Joanna Długosińska
Emilia Musiał
Jacek Gałczyński
Marek Dedecjus
References (28)- Mazzaferri EL, Kloos RT. Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab. 2001; 86(4): 1447–1463.
- Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998; 338(5): 297–306.
- Choi Y, Park KJ, Ryu S, et al. Papillary thyroid carcinoma involving cervical neck lymph nodes: correlations with lymphangiogenesis and ultrasound features. Endocr J. 2012; 59(10): 941–948.
- Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016; 26(1): 1–133.
- Hall TL, Layfield LJ, Philippe A, et al. Sources of diagnostic error in fine needle aspiration of the thyroid. Cancer. 1989; 63(4): 718–725, doi: 10.1002/1097-0142(19890215)63:4<718::aid-cncr2820630420>3.0.co;2-n.
- Frasoldati A, Valcavi R. Challenges in neck ultrasonography: lymphadenopathy and parathyroid glands. Endocr Pract. 2004; 10(3): 261–268.
- Torres MR, Nóbrega Neto SH, Rosas RJ, et al. Thyroglobulin in the washout fluid of lymph-node biopsy: what is its role in the follow-up of differentiated thyroid carcinoma? Thyroid. 2014; 24(1): 7–18.
- Pacini F, Fugazzola L, Lippi F, 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(6): 1401–1404.
- Zhu XH, Zhou JN, Qian YY, et al. Diagnostic values of thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis diagnostic values of FNA-Tg. Endocr J. 2020; 67(2): 113–123.
- Kim MJ, Kim EK, Kim BM, 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(1): 145–151.
- Sohn YM, Kim MJ, Kim EK, et al. Diagnostic performance of thyroglobulin value in indeterminate range in fine needle aspiration washout fluid from lymph nodes of thyroid cancer. Yonsei Med J. 2012; 53(1): 126–131.
- Filetti S, Durante C, Hartl D, et al. ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019; 30(12): 1856–1883.
- Bournaud C, Charrié A, Nozières C, et al. Thyroglobulin measurement in fine-needle aspirates of lymph nodes in patients with differentiated thyroid cancer: a simple definition of the threshold value, with emphasis on potential pitfalls of the method. Clin Chem Lab Med. 2010; 48(8): 1171–1177.
- Borel AL, Boizel R, Faure P, 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(5): 691–698.
- Jeon MJi, Park JW, Han JiM, et al. Serum antithyroglobulin antibodies interfere with thyroglobulin detection in fine-needle aspirates of metastatic neck nodes in papillary thyroid carcinoma. J Clin Endocrinol Metab. 2013; 98(1): 153–160.
- Grani G, Lamartina L, Durante C, et al. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol. 2018; 6(6): 500–514.
- Kure S, Ohashi R. Thyroid Hürthle Cell Carcinoma: Clinical, Pathological, and Molecular Features. Cancers (Basel). 2020; 13(1).
- Florentine BD, Staymates B, Rabadi M, et al. Cancer Committee of the Henry Mayo Newhall Memorial Hospital. The reliability of fine-needle aspiration biopsy as the initial diagnostic procedure for palpable masses: a 4-year experience of 730 patients from a community hospital-based outpatient aspiration biopsy clinic. Cancer. 2006; 107(2): 406–416.
- Machens A, Hinze R, Thomusch O, et al. Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg. 2002; 26(1): 22–28.
- Yeh MW, Bauer AJ, Bernet VA, et al. American Thyroid Association Surgical Affairs Committee Writing Task Force. American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid. 2015; 25(1): 3–14.
- Roy R, Kouniavsky G, Venkat R, et al. The role of preoperative neck ultrasounds to assess lymph nodes in patients with suspicious or indeterminate thyroid nodules. J Surg Oncol. 2012; 105(6): 601–605.
- Moon JH, Kim YIl, Lim JAh, et al. Thyroglobulin in washout fluid from lymph node fine-needle aspiration biopsy in papillary thyroid cancer: large-scale validation of the cutoff value to determine malignancy and evaluation of discrepant results. J Clin Endocrinol Metab. 2013; 98(3): 1061–1068.
- Torres MR, Nóbrega Neto SH, Rosas RJ, et al. Thyroglobulin in the washout fluid of lymph-node biopsy: what is its role in the follow-up of differentiated thyroid carcinoma? Thyroid. 2014; 24(1): 7–18.
- Ringel MD, Nabhan F. Approach to follow-up of the patient with differentiated thyroid cancer and positive anti-thyroglobulin antibodies. J Clin Endocrinol Metab. 2013; 98(8): 3104–3110.
- Boi F, Baghino G, Atzeni F, et al. 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(4): 1364–1369.
- 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(11): 959–963.
- Purkait S, Agarwal S, Mathur SR, et al. Fine needle aspiration cytology features of poorly differentiated thyroid carcinoma. Cytopathology. 2016; 27(3): 176–184.
- Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M. Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. Endocr Pathol. 2020; 31(3): 197–217.
