Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytology?

Enke Baldini,Salvatore Ulisse,Paolo Miccoli,Lucio Gnessi,Alessandro Antonelli,Eleonora D’Armiento,Cira Di Gioia,Corrado De Vito,Giovanni Carbotta,Salvatore Sorrenti,Enrico De Antoni

doi:10.1186/1472-6890-13-7

Enke Baldini, Salvatore Ulisse + Show 9 more

Open Access

https://doi.org/10.1186/1472-6890-13-7

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Abstract

BackgroundMeasurement of thyroglobulin (Tg) protein in the washout of the needle used for fine needle aspiration biopsy cytology (FNAB-C) has been shown to increase the sensitivity of FNAB-C in identifying cervical lymph node (CLN) metastasis from well-differentiated thyroid cancer (TC). In this study, we evaluated whether routine measurement of Tg protein (FNAB-Tgp), Tg mRNA (FNAB-Tgm) and calcitonin (CT) mRNA (FNAB-CTm) in the FNAB washout of CLN increases the accuracy of FNAB-C in the diagnosis of suspicious metastatic CLN.MethodsIn this prospective study 35 CLN from 28 patients were examined. Histology showed metastatic papillary TC (PTC) in 26 CLN, metastatic medullary TC (MTC) in 3 CLN, metastatic anaplastic TC (ATC) in 3 CLN and 3 metastatic CLN from extra-thyroidal cancers.ResultsThe overall accuracy of FNAB-C was 84.4%, reaching 95.7% when the analysis was restricted to PTC. Both FNAB-Tgp and FNAB-Tgm compared favorably with FNAB-C and shown diagnostic performances not statistically different from that of FNAB-C. However, FNAB-Tgp and FNAB-Tgm/FNAB-CTm were found useful in cases in which cytology results were inadequate or provided diagnosis inconsistent with patient's clinical parameters.ConclusionsWe demonstrated that FNAB-C, Tg/CT mRNA and Tg protein determination in the fine-needle washout showed similar accuracy in the diagnosis of metastatic CLN from TC. The results of this study suggest that samples for Tg protein and Tg/CT mRNA measurements from CLN suspicious for metastatic TC should be collected, but their measurements should be restricted to cases in which FNAB-C provides uninformative or inconsistent diagnosis with respect to patient's clinical parameters.

Highlights

Measurement of thyroglobulin (Tg) protein in the washout of the needle used for fine needle aspiration biopsy cytology (FNAB-C) has been shown to increase the sensitivity of fine-needle aspiration biopsy (FNAB)-C in identifying cervical lymph node (CLN) metastasis from well-differentiated thyroid cancer (TC)
Over the last two decades, a number of studies have demonstrated that measurement of thyroglobulin protein (Tgp) in the washout of the needle used for FNAB (FNAB-Tgp) increases the sensitivity of FNAB-C in identifying CLN metastasis from DTC [14,15,16,17,18,19,20,21,22,23,24,25,26,27]
In the present work we evaluated, in 35 consecutive CLN for which the histological diagnosis was available, if routine measurement of thyroglobulin (Tg) protein and Tg and calcitonin (CT) mRNA in the washout of the needle used for FNAB increases the sensitivity of FNAB-C in identifying cervical lymph node (CLN) metastasis from either DTC or medullary TC (MTC)

Summary

Introduction

Measurement of thyroglobulin (Tg) protein in the washout of the needle used for fine needle aspiration biopsy cytology (FNAB-C) has been shown to increase the sensitivity of FNAB-C in identifying cervical lymph node (CLN) metastasis from well-differentiated thyroid cancer (TC). Thyroid carcinomas originate mostly standard technique for the detection of cervical lymph node (CLN) metastasis [4,5,6,7,8,9] The latter, relies on the experience and ability of the cytopathologist, and may be a challenging diagnostic category as CLN could harbor metastasis from a multiplicity of extrathyroidal malignancies or be affected by several non-tumoral diseases [9,10,11]. It has been shown that lymph node detection of Tg mRNA (Tgm) in fineneedle washout implemented the FNAB-C sensitivity for the diagnosis of metastatic CLN from DTC, even if this still needs to be validated on larger case-studies [28]

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