Уважаемые пользователи!

Данный сайт содержит информацию для людей с медицинским образованием и специалистов здравоохранения.
Входя на сайт, Вы подтверждаете свое согласие с Условиями использования и Политикой конфиденциальности.



Dear visitor!
This site contains medical information for healthcare professionals.
You can go further, if you agree with Terms and Conditions and Privacy Policy on this site.

Thyroglobulin measurement in fine-needle aspirates of lymph nodes in patients with differentiated thyroid cancer.

Abstract


Abstract. The high incidence of cervical lymph nodes metastasis in highly differentiated thyroid carcinoma (DTC) and insufficient of existing diagnostic methods determines the urgency of finding reliable and more effective tests.

Aim. The aim of our study is to determine the prognostic significance of the thyroglobulin measurement in washout fluid from fine-needle aspiration biopsy (FNA-Tg) and the cut-off value in the diagnosis of DTC lymph nodes metastasis.

Matherials and Methods. 191 (53 men/138 women) patients evaluated for suspicious cervical lymph nodes were retrospectively reviewed. All patients underwent FNA-Tg, serum thyroglobulin (sTg) levels, thyroglobulin antibodies (Tg Ab), thyroid-stimulating hormone (TSH) were measured. 108 patients with malignant changes according to FNA and/or high FNA-Tg values ​​underwent surgical treatment. Patients were divided into 2 groups with reactive (n = 14) and metastatic (n = 94) changes. FNA-TG was assayed on automated system Cobas 601 (Roche, France). The U-test Mann-Whitney was performed to evaluate the differences between groups. The diagnostic performances of FNA cytology with FNA-Tg was analyzed by comparing of the areas under the ROC-curve (ROC-AUC). Analysis was performed by SPSSv23. The ROC-curve was developed by using MedCalc for Windows, Version 18.2.1 (MedCalc Software, Mariakerke, Belgium). Statistical significance was determined when the p - value was < 0.05.

Results: All patients were comparable by sex, age and levels of TSH, sTG, Tg Ab. The FNA-Tg median in metastatic group was 595,50 [0,1; 1000], and in benign group - 2.47 [0.5; 9.2], p <0.001. The sensitivity of isolated FNA was 85 %, specificity 57 %, AUC = 0,618, 95% CI 0,516-0,713. The sensitivity and specificity of FNA-Tg was 73% and 100%, respectively, AUC = 0.865, 95% CI 0.78-0.92. The optimal cut-off point for malignancy was > 9.2 ng/ml (sensitivity 75%, specificity 100%), Youden Index  0.73.

Conclusion: Additional FNA-Tg may increase the sensitivity of isolated FNA in evaluation of DTC lymph node metastasis. The optimized cutoff value ​​> 9.2 ng/ml can be proposed as a diagnostic threshold for the definition of malignancy.


Zamira Zuraeva

ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава РФ

Author for correspondence.
Email: zuraeva_zamira@mail.ru
ORCID iD: 0000-0001-6953-6928
SPIN-code: 6002-0455
Mendeley Profile: https://www.mendeley.com/profiles/zamira-zuraeva/

Russian Federation,  117036, Россия, Москва, улица Дм.Ульянова, д.11

научный сотрудник

Larisa Nikankina

ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава РФ

Email: larisa.nikankina@yandex.ru
ORCID iD: 0000-0002-1120-8240
SPIN-code: 2794-0008

Russian Federation,  117036, Россия, Москва, улица Дм.Ульянова, д.11

кандидат медицинских наук, врач высшей квалификационной категории, ведущий научный сотрудник клинико-диагностической лаборатории

Galina Kolesnikova

ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава РФ

Email: kolesnikova21@yandex.ru
ORCID iD: 0000-0002-3121-5122
SPIN-code: 7716-9680

Russian Federation,  117036, Россия, Москва, улица Дм.Ульянова, д.11

доктор биологических наук, биохимик-эндокринолог,главный научный сотрудник клинико-диагностической лаборатории

Fatima Abdulhabirova

ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава РФ

Email: a-fatima@yandex.ru
SPIN-code: 2462-1115

Russian Federation, 117036, Россия, Москва, улица Дм.Ульянова, д.11

кандидат медицинских наук, врач высшей квалификационной категории отдела терапевтической эндокринологии, врач клинической лабораторной диагностики, заведующая лабораторией цитологии и цитогенетики отдела фундаментальной патоморфологии

Pavel Rumiantsev

ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава РФ

Email: pavelrum@gmail.com
ORCID iD: 0000-0002-7721-634X
SPIN-code: 7085-7976

Russian Federation, 117036, Россия, Москва, улица Дм.Ульянова, д.11

доктор медицинских наук, врач высшей квалификационной категории, заместитель директора Центра по радиологии и радиационной безопасности, заведующий отделом радионуклидной диагностики и терапии

Vladimir Vanushko

ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава РФ

Email: vanushko.thyroid@gmail.com
ORCID iD: 0000-0001-6338-7490
SPIN-code: 6097-8990

Russian Federation, 117036, Россия, Москва, улица Дм.Ульянова, д.11

доктор медицинских наук, главный научный сотрудник отдела хирургии

Natalia Malysheva

ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава РФ

Email: natalya.m@list.ru
ORCID iD: 0000-0001-7321-9052
SPIN-code: 5793-2550

Russian Federation, 117036, Россия, Москва, улица Дм.Ульянова, д.11

кандидат биологических наук, старший научный сотрудник клиник-диагностической лаборатории

  • Ванушко В.Э., Цуркан А.Ю. Лечение дифференцированного рака щитовидной железы: состояние проблем// Клиническая и экспериментальная тиреоидология.- 2010.- № 2 (6).-С.24-33.[ Vanushko V.E., Tsurkan A.Y. Treatment of differentiated thyroid cancer : cureunt statement of the problem. Clinical and experimental thyroidology. 2010;2(6):24-33. (in Russ.).]
  • Mazzaferri EL, Kloos RT. Current Approaches to Primary Therapy for Papillary and Follicular Thyroid Cancer. J Clin Endocrinol Metab. 2001;86(4):1447-1463. doi: 10.1210/jcem.86.4.7407.
  • Бельцевич Д.Г., Ванушко В.Э., Румянцев П.О., и др. Российские клинические рекомендации по диагностике и лечению высокодифференцированного рака щитовидной железы у взрослых, 2017//Эндокринная хирургия.- 2017.-№ 1 (11).- С.6-27. [Beltsevich D.G., Vanushko V.E., Rumiantsev P.O. 2017 Russian clinical practice guidelines for differentiated thyroid cancer diagnosis and treatment. Endocrine Surgery.2017; 1 (11): 6-27.in Russ.).] doi: 10.14341/serg201716.
  • Kouvaraki M.A., Shapiro S.E., Fornage B.D., et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134(6):946-955. doi: 10.1016/S0039-6060(03)00424-0.
  • Stulak JM, Grant CS, Farley DR, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg. 2006;141(5):489-496. doi: 10.1001/archsurg.141.5.489.
  • Maia FFR, Matos PS, Pavin EJ, Vassallo J, Zantut-Wittmann DE. Value of repeat ultrasound-guided fine-needle aspiration in thyroid nodule with a first benign cytologic result: Impact of ultrasound to predict malignancy. Endocrine. 2011;40(2):290-296. doi: 10.1007/s12020-011-9467-0.
  • Frasoldati A, Toschi E, Zini M, et al. Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid. 1999;9(2):105-111. doi: 10.1089/thy.1999.9.105.
  • Hasbek Z, Turgut B, Kilicli F, et al. Importance of Postoperative Stimulated Thyroglobulin Level at the Time of 131 I Ablation Therapy for Differentiated Thyroid Cancer. Asian Pacific J Cancer Prev. 2014;15(6):2523-2527. doi: 10.7314/APJCP.2014.15.6.252.
  • Pacini FUR, Fugazzola L, Miccoli P, 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(6):1401-4.
  • Ross S, Simeone F, Mueller R, et al. Fine-needle biopsy of cervical lymph nodes in patients with thyroid cancer: a prospective comparison of cytopathologic and tissue marker analysis. Radiology. 1993;187(3):851-4.
  • Cooper S D, Doherty GM, Haugen BR, et al. Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2009;19(11):1-48. doi: 10.1089/thy.2009.0110.
  • Stack BC, Ferris RL, Goldenberg D, et al. American Thyroid Association Consensus Review and Statement Regarding the Anatomy, Terminology, and Rationale for Lateral Neck Dissection in Differentiated Thyroid Cancer. Thyroid. 2012;22(5):501-508. doi: 10.1089/thy.2011.0312.
  • Leenhardt L, Erdogan MF, Hegedus L, et al. 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(3):147-159. doi: 10.1159/000354537.
  • 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. doi: 10.1210/jc.2005-1705.
  • Borel A-L, 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. doi: 10.1530/EJE-07-0749.
  • 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. doi: 10.1111/j.1365-2265.2008.03297.x.
  • 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. doi: 10.1515/CCLM.2010.220.
  • Camargo J, Migliavacca A, Guimarães JR, et al. Tiroglobulin measurements in washout of fine needle aspirates in cervical lymph nodes for detection of papillary thyroid cancer metastases. Arq Bras Endocrinol Metab. 2010;54(6):550-554.
  • 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. doi: 10.3349/ymj.2012.53.1.126.
  • Snozek CLH, 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(11):4278-4281. doi: 10.1210/jc.2007-1075.
  • 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(1):101-107. doi: 10.1530/EJE-07-0088.
  • Cignarelli M, Ambrosi A, Marino A, et al. Diagnostic Utility of Thyroglobulin Detection in Fine-Needle Aspiration of Cervical Cystic Metastatic Lymph Nodes from Papillary Thyroid Cancer with Negative Cytology.Thyroid.2003;13(12):1163-1167. doi: 10.1089/10507250360731578.
  • Jeon SJ, Kim E, Park JS, et al. Diagnostic benefit of thyroglobulin measurement in fine-needle aspiration for diagnosing metastatic cervical lymph nodes from papillary thyroid cancer: Correlations with us features. Korean J Radiol. 2009;10(2):106-111. doi: 10.3348/kjr.2009.10.2.106.
  • Uruno T, Miyauchi A, Shimizu K, et al. Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg. 2005;29(4):483-485. doi: 10.1007/s00268-004-7701-0.
  • Sturgeon CM, Hoffman BR, Chan DW, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Clinical Practice: Quality Requirements. Clin Chem. 2008;54(8):e1-e10. doi: 10.1373/clinchem.2007.094144.
  • Charrié A, Anne C. The Thyroglobulin : A Technically Challenging Assay for a Marker of Choice During the Follow-Up of Differentiated Thyroid Cancer. Thyroid Parathyr Dis - New Insights into Some Old Some New Issues. 2012:318.

Views

Abstract - 33

PDF (Russian) - 12


Copyright (c) Zuraeva Z., Nikankina L., Kolesnikova G., Abdulhabirova F., Rumiantsev P., Vanushko V., Malysheva N.

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.