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Measurement of Thyroid Tumor Markers on Fine-Needle Washouts

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Atlas of Thyroid and Neuroendocrine Tumor Markers

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Abstract

Generally, thyroglobulin (Tg), calcitonin (CT), and PTH are determined in blood. However, in the last decades, these molecules have been measured in fluids from FNA of neck lymph nodes (FNA-Tg and FNA-CT), thyroid nodules (FNA-CT), or suspicious parathyroids (FNA-PTH). These measurements rapidly emerged as powerful and relatively cheap tools to refine challenging clinical diagnosis in patients with thyroid/parathyroid lesions and have been included in international guidelines. Nevertheless, a definitive standardization of these procedures has not yet been reached, and further efforts should be made in order to better define pre-analytical, analytical, and post-analytical aspects. Also, a close cooperation between laboratory specialists, pathologists, and clinicians involved in thyroid/parathyroid diseases’ care is mandatory to define the most appropriate procedures.

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References

  1. Haugen BR Md, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, Pacini F, Randolph G, Sawka A, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward D, Tuttle RM Md, Wartofsky L. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2015; 26(1):1–133.

    Google Scholar 

  2. Pacini F, Fugazzola L, Lippi F, Ceccarelli C, Centoni R, Miccoli P, Elisei R, Pinchera A. 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;74:1401–4.

    CAS  PubMed  Google Scholar 

  3. Giovanella L, Bongiovanni M, Trimboli P. Diagnostic value of thyroglobulin assay in cervical lymph node fine-needle aspirations for metastatic differentiated thyroid cancer. Curr Opin Oncol. 2013;25:6–13.

    Article  CAS  PubMed  Google Scholar 

  4. Trimboli P, Guidobaldi L, Bongiovanni M, Crescenzi A, Alevizaki M, Giovanella L. Use of fine-needle aspirate calcitonin to detect medullary thyroid carcinoma: A systematic review. Diagn Cytopathol. 2016;44:45–51.

    Article  PubMed  Google Scholar 

  5. Trimboli P, Treglia G, Guidobaldi L, Romanelli F, Nigri G, Valabrega S, Sadeghi R, Crescenzi A, Faquin WC, Bongiovanni M, Giovanella L. Detection rate of FNA cytology in medullary thyroid carcinoma: a meta-analysis. Clin Endocrinol. 2015;82:280–5.

    Article  Google Scholar 

  6. Bugalho MJ, Santos JR, Sobrinho L. Preoperative diagnosis of medullary thyroid carcinoma: fine needle aspiration cytology as compared with serum calcitonin measurement. J Surg Oncol. 2005;91:56–60.

    Article  PubMed  Google Scholar 

  7. Essig GF Jr, Porter K, Schneider D, Debora A, Lindsey SC, Busonero G, Fineberg D, Fruci B, Boelaert K, Smit JW, Meijer JA, Duntas L, Sharma N, Costante G, Filetti S, Sippel RS, Biondi B, Topliss DJ, Pacini F, Maciel RM, Walz PC, Kloos RT. Fine needle aspiration and medullary thyroid carcinoma: the risk of inadequate preoperative evaluation and initial surgery when relying upon FNAB cytology alone. Endocr Pract. 2013;19:920–7.

    Article  PubMed  Google Scholar 

  8. Pusztaszeri MP, Bongiovanni M, Faquin WC. Update on the cytologic and molecular features of medullary thyroid carcinoma. Adv Anat Pathol. 2014;21:26–35.

    Article  PubMed  Google Scholar 

  9. Wells SA Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee NY, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah MH Md, Waguespack SG. Revised American Thyroid Association Guidelines for the Management of Medullary Thyroid Carcinoma The American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Thyroid. 2015;25:567–610.

    Google Scholar 

  10. Mihai R, Gleeson F, Buley ID, Roskell DE, Sadler GP. Negative imaging studies for primary hyperparathyroidism are unavoidable: correlation of sestamibi and high-resolution ultrasound scanning with histological analysis in 150 patients. World J Surg. 2006;30:697–704.

    Article  PubMed  Google Scholar 

  11. Marcocci C, Mazzeo S, Bruno-Bossio G, Picone A, Vignali E, Ciampi M, Viacava P, Naccarato AG, Miccoli P, Iacconi P, et al. Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates. Eur J Endocrinol. 1998;139:72–7.

    Article  CAS  PubMed  Google Scholar 

  12. Grani G, Fumarola A. Thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis of diagnostic accuracy. J Clin Endocrinol Metab. 2014;99:1970–82.

    Article  CAS  PubMed  Google Scholar 

  13. 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;91:1364–9.

    Article  CAS  PubMed  Google Scholar 

  14. Cunha N, Rodrigues F, Curado F, 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;157:101–7.

    Article  CAS  PubMed  Google Scholar 

  15. Bournaud C, Charrié A, Nozieres 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;48:1171–7.

    Article  CAS  PubMed  Google Scholar 

  16. Salmashoglu A, Erbil Y, Citlak G, et al. Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary carcinoma. Langenbeck's Arch Surg. 2011;396:77–81.

    Article  Google Scholar 

  17. Sigstad E, Heilo A, Paus E, et al. The usefulness of detecting thyroglobulin in fine-needle aspirates from patients with neck lesions using a sensitive thyroglobulin assay. Diagn Cytopathol. 2007;35:761–7.

    Article  CAS  PubMed  Google Scholar 

  18. Kim DW, Jeon SJ, Kim CG. Usefulness of thyroglobulin measurement in needle washouts of fine-needle aspiration biopsy for the diagnosis of cervical lymph node metastases from papillary thyroid cancer before thyroidectomy. Endocrine. 2012;42:399–403.

    Article  CAS  PubMed  Google Scholar 

  19. 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;53:126–31.

    Article  CAS  PubMed  Google Scholar 

  20. Snozek CL, Chambers EP, Reading CC, et al. Serum thyroglobulin, high resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin Endocrinol Metab. 2007;92:4278–81.

    Article  CAS  PubMed  Google Scholar 

  21. Moon JH, Kin YL, Lim JA, Choi HS, Cho SW, Kim KW, 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;98:1061–8.

    Article  CAS  PubMed  Google Scholar 

  22. Giovanella L, Ceriani L, Suriano S, et al. Thyroglobulin measurement on fine needle washout fluids: Influence of sample collection methods. Diagn Cytopathol. 2009;37:42–4.

    Article  PubMed  Google Scholar 

  23. 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. 2009;70:145–51.

    Article  CAS  Google Scholar 

  24. Cappelli C, Pirola I, De Martino E, Gandossi E, Cimino E, Samoni F, et al. Thyroglobulin measurement in fine-needle aspiration biopsy of metastatic lymph nodes after rhTSH stimulation. Head Neck. 2013;35:E21–3.

    Article  PubMed  Google Scholar 

  25. Giovanella L. Lymph nodes thyroglobulin measurement after rhTSH stimulation. Head Neck. 2013;35:146.

    Article  PubMed  Google Scholar 

  26. Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P. AACE/AME/ETA Task Force on Thyroid Nodules American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2010;16:468–75.

    Article  PubMed  Google Scholar 

  27. Leenhardt L, Erdogan MF, Hegedus L, Mandel SJ, Paschke R, Rago T, Russ G. 2013 European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques in the Postoperative Management of Patients with Thyroid Cancer. Eur Thyroid J. 2013;2:147–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R. Vitti P; AACE/ACE/AME Task Force on Thyroid Nodules. American Association of Clinical Endocrinologists, American College of Endocrinologist, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules - 2016 update. Endocr Pract. 2016;22:622–39.

    Article  PubMed  Google Scholar 

  29. Boi F, Maurelli I, Pinna G, Atzeni F, Piga M, Lai ML, Mariotti S. Calcitonin measurement in wash-out fluid from fine needle aspiration of neck masses in patients with primary and metastatic medullary thyroid carcinoma. J Clin Endocrinol Metab. 2007;92:2115–8.

    Article  CAS  PubMed  Google Scholar 

  30. Kudo T, Miyauchi A, Ito Y, Takamura Y, Amino N, Hirokawa M. Diagnosis of medullary thyroid carcinoma by calcitonin measurement in fine-needle aspiration biopsy specimens. Thyroid. 2007;17:635–8.

    Article  PubMed  Google Scholar 

  31. Trimboli P, Cremonini N, Ceriani L, Saggiorato E, Guidobaldi L, Romanelli F, Ventura C, Laurenti O, Messuti I, Solaroli E, Madaio R, Bongiovanni M, Orlandi F, Crescenzi A, Valabrega S, Giovanella L. Calcitonin measurement in aspiration needle washout fluids has higher sensitivity than cytology in detecting medullary thyroid cancer: a retrospective multicentre study. Clin Endocrinol. 2014;80:135–40.

    Article  CAS  Google Scholar 

  32. Diazzi C, Madeo B, Taliani E, Zirilli L, Romano S, Granata AR, De Santis MC, Simoni M, Cioni K, Carani C, Rochira V. The diagnostic value of calcitonin measurement in wash-out fluid from fine-needle aspiration of thyroid nodules in the diagnosis of medullary thyroid cancer. Endocr Pract. 2013;19:769–79.

    Article  PubMed  Google Scholar 

  33. De Crea C, Raffaelli M, Maccora D, Carrozza C, Canu G, Fadda G, Bellantone R, Lombardi CP. Calcitonin measurement in fine-needle aspirate washouts vs. cytologic examination for diagnosis of primary or metastatic medullary thyroid carcinoma. Acta Otorhinolaryngol Ital. 2014;34:399–405.

    PubMed  Google Scholar 

  34. Trimboli P, Nigri G, Romanelli F, Cicciarella Modica DD, Crescenzi A, Valabrega S, Giovanella L. Medullary thyroid nodules by measurement of calcitonin (Ct) in aspiration needle washout in patients with multinodular goiter and moderately elevated serum Ct. Exp Clin Endocrinol Diabetes. 2012;120:234–7.

    Article  CAS  PubMed  Google Scholar 

  35. Trimboli P, Rossi F, Baldelli R, Laurenti O, Nigri G, Ventura C, Appetecchia M, Attanasio D, Romanelli F, Guidobaldi L, Guarino M, Crescenzi A, Valabrega S. Measuring calcitonin in washout of the needle in patients undergoing fine needle aspiration with suspicious medullary thyroid cancer. Diagn Cytopathol. 2012;40:394–8.

    Article  CAS  PubMed  Google Scholar 

  36. Giovanella L, Ceriani L, Bongiovanni M. Calcitonin measurement on fine needle washouts: preanalytical issues and normal reference values. Diagn Cytopathol. 2013;41:226–9.

    Article  PubMed  Google Scholar 

  37. Trimboli P, Giovanella L. Serum calcitonin negative medullary thyroid carcinoma: a systematic review of the literature. Clin Chem Lab Med. 2015;53:1507–14.

    Article  CAS  PubMed  Google Scholar 

  38. Doppman JL, Krudy AG, Marx SJ, Saxe A, Schneider P, Norton JA, Spiegel AM, Downs RW, Schaaf M, Brennan ME, Schneider AB, Aurbach GD. Aspiration of enlarged parathyroid glands for parathyroid hormone assay. Radiology. 1983;148:31–5.

    Article  CAS  PubMed  Google Scholar 

  39. Sacks BA, Pallotta JA, Cole A, Hurwitz J. Diagnosis of parathyroid adenomas: efficacy of measuring parathormone levels in needle aspirates of cervical masses. AJR Am J Roentgenol. 1994;163:1223–6.

    Article  CAS  PubMed  Google Scholar 

  40. Kiblut NK, Cussac J-F, Soudan B, Farrel SG, Armstrong JA, Arnalsteen L, et al. Fine needle aspiration and intraparathyroid hormone measurement for reoperative parathyroid surgery. World J Surg. 2004;28:1143–7.

    Article  PubMed  Google Scholar 

  41. Conrad DN, Jordan EO, Hartwig HM, Mack E, Chen H. A prospective evaluation of novel methods to intraoperatively distinguish parathyroid tissue utilizing a parathyroid hormone assay. J Surg Res. 2006;133:38–41.

    Article  CAS  PubMed  Google Scholar 

  42. Kwak JY, Kim E-K, Moon HJ, Kim MJ, Ahn SS, Son EJ, Sohn YM. Parathyroid incidentalomas detected on routine ultrasound-directed fine-needle aspiration biopsy in patients referred for thyroid nodules and the role of parathyroid hormone analysis in samples. Thyroid. 2009;19:743–8.

    CAS  PubMed  Google Scholar 

  43. Boi F, Lombardo C, Cocco MC, Cocco MC, Piga M, Serra A, et al. Thyroid diseases cause mismatch between MIBI scan and neck ultrasound in the diagnosis of hyperfunctioning parathyroids: usefulness of FNA-PTH assay. Eur J Endocrinol. 2012;168:49–58.

    Article  PubMed  Google Scholar 

  44. Kuzu F, Arpaci D, Cakmak GK, Emre AU, Elri T, Ilikhan SU, et al. Focused parathyroidectomy without intra-operative parathormone monitoring: The value of PTH assay in preoperative ultrasound guided fine needle aspiration washout. Ann Med Surg (Lond). 2016;6:64–7.

    Article  Google Scholar 

  45. Suh YJ, Son EJ, Moon HJ, Kim EK, Han KH, Kwak JY. Utility of thyroglobulin measurements in fine-needle aspirates of space occupying lesions in the thyroid bed after thyroid cancer operations. Thyroid. 2013;23:280–8.

    Article  CAS  PubMed  Google Scholar 

  46. Popowicz B, Klencki M, Sporny S, Jankiewicz-Wika J, Komorowski J, Pisarek H, Słowińska-Klencka D. Usefulness of PTH measurements in FNAB washouts in the identification of pathological parathyroids – analysis of the factors that influence the effectiveness of this method. Endocrynol Pol. 2014;65:25–32.

    Article  CAS  Google Scholar 

  47. Familiar Casado C, Antón Bravo T, Moraga Guerrero I, Ramos Carrasco A, García García C, Villanueva Curto S. The value of thyroglobulin in washout of fine needle aspirate from 16 cervical lesions in patients with thyroid cancer. Endocrinol Nutr. 2013;60:495–503.

    Article  CAS  PubMed  Google Scholar 

  48. Censi S, Cavedon E, Fernando SW, Barollo S, Bertazza L, Zambonin L, et al. Calcitonin measurement and immunoassay interference: a case report and literature review. Clin Chem Lab Med. 2016;54(12):1861–70. https://doi.org/10.1515/cclm-2015-1161.

    Article  CAS  PubMed  Google Scholar 

  49. Giovanella L, Feldt-Rasmussen U, Verburg FA, Grebe SK, Plebani M, Clark PM. Thyroglobulin measurement by highly sensitive assays: focus on laboratory challenges. Clin Chem Lab Med. 2015;53:1301–14.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Via Ospedale 12, 6500, Bellinzona, Switzerland

    Pierpaolo Trimboli & Luca Giovanella

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  1. Pierpaolo Trimboli
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  2. Luca Giovanella
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Correspondence to Pierpaolo Trimboli .

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  1. Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    Luca Giovanella

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Trimboli, P., Giovanella, L. (2018). Measurement of Thyroid Tumor Markers on Fine-Needle Washouts. In: Giovanella, L. (eds) Atlas of Thyroid and Neuroendocrine Tumor Markers. Springer, Cham. https://doi.org/10.1007/978-3-319-62506-5_13

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  • DOI: https://doi.org/10.1007/978-3-319-62506-5_13

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