Abstract
Purpose
We aimed to compare the diagnostic value of fine-needle aspiration cytology (FNAC) and fine-needle aspiration thyroglobulin measurements (FNA-Tg) for detecting cervical lymph node metastases from differentiated thyroid carcinomas.
Methods
This prospective study included 225 patients with neck node metastases or recurrences of papillary thyroid carcinoma. From the 225 patients, 255 lymph nodes were evaluated by FNAC and FNA-Tg. Final diagnoses confirmed by histological examination were compared to preoperative FNAC and FNA-Tg results.
Results
FNAC correctly diagnosed 212 metastatic lymph nodes but failed to diagnose 43 of them. FNA-Tg correctly diagnosed 253 metastatic lymph nodes but failed to diagnose two of them. FNA-Tg levels showed 100% sensitivity, 96% specificity, 99% diagnostic accuracy, a 99% positive predictive value (PPV) and a 100% negative predictive value (NPV) with a threshold level of FNA-Tg with a diagnostic accuracy 28.5 ng/ml. The specificity, diagnostic accuracy, PPV and NPV of FNA-Tg were significantly higher than those of FNAC.
Conclusion
FNA-Tg measurement can be performed safely for the detection of lymph node metastasis in patients with differentiated thyroid carcinomas.
Similar content being viewed by others
References
Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL et al (2009) American Thyroid Association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214
Mazzaferri EL, Kloos RT (2001) Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 86:1447–1463
Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803
Sakorafas GH, Sampanis D, Safioleas M (2010) Cervical lymph node dissection in papillary thyroid cancer: current trends, persisting controversies, and unclarified uncertainties. Surg Oncol 19:57–70
Pacini F, Fugazzola L, Lippi F, Ceccarelli C, Centoni R, Miccoli P et al (1992) 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 74:1401–1404
Frasoldati A, Toschi E, Zini M, Flora M, Caroggio A, Dotti C et al (1999) Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid 9:105–111
Cunha N, Rodrigues F, Curado F, Ilhéu O, Cruz C, Naidenov P et al (2007) Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: a technique for the diagnosis of metastatic differentiated thyroid cancer. Eur J Endocrinol 157:101–107
Borel AL, Boizel R, Faure P, Barbe G, Boutonnat J, Sturm N et al (2008) 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 158:691–698
Snozek CL, Chambers EP, Reading CC, Sebo TJ, Sistrunk JW, Singh RJ et al (2007) Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin Endocrinol Metab 92:4278–4281
Boi F, Baghino G, Atzeni F, Lai ML, Faa G, Mariotti S (2006) 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 91:1364–1369
Baloch ZW, Barroeta JE, Walsh J, Gupta PK, Livolsi VA, Langer JE et al (2008) Utility of thyroglobulin measurement in fine-needle aspiration biopsy specimens of lymph nodes in the diagnosis of recurrent thyroid carcinoma. Cytojournal 31:1–5
Kim MJ, Kim EK, Kim BM, Kwak JY, Lee EJ, Park CS et al (2009) Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer. Clin Endocrinol 70:145–151
Torlontano M, Attard M, Crocetti U, Tumino S, Bruno R, Costante G et al (2004) Follow-up of low risk patients with papillary thyroid cancer: role of neck ultrasonography in detecting lymph node metastases. J Clin Endocrinol Metab 89:3402–3407
Francis Z, Schlumberger M (2008) Serum thyroglobulin determination in thyroid cancer patients. Best Pract Res Clin Endocrinol Metab 22:1039–1046
Zucchelli G, Iervasi A, Ferdeghini M, Iervasi G (2009) Serum thyroglobulin measurement in the follow-up of patients treated for differentiated thyroid cancer. Q J Nucl Med Mol Imaging 53:482–489
Elisei R, Schlumberger M, Driedger A, Reiners C, Kloos RT, Sherman SI et al (2009) Follow-up of low-risk differentiated thyroid cancer patients who underwent radioiodine ablation of postsurgical thyroid remnants after either recombinant human thyrotropin or thyroid hormone withdrawal. J Clin Endocrinol Metab 94:4171–4179
Leboulleux S, Girard E, Rose M, Sabbah N, Caillou B, Hartl DM et al (2007) Ultrasound criteria of malignancy for cervical lymph nodes in patients followed up for differentiated thyroid cancer. J Clin Endocrinol Metab 92:3590–3594
Kuna SK, Bracic I, Tesic V, Kuna K, Herceg GH, Dodig D (2006) Ultrasonographic differentiation of benign from malignant neck lymphadenopathy in thyroid cancer. J Ultrasound Med 25:1531–1537
Frasoldati A, Valcavi R (2004) Challenges in neck ultrasonography: lymphadenopathy and parathyroid glands. Endocr Pract 10:261–268
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salmaslıoğlu, A., Erbil, Y., Çıtlak, G. et al. Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary thyroid carcinoma. Langenbecks Arch Surg 396, 77–81 (2011). https://doi.org/10.1007/s00423-010-0723-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-010-0723-1