Abstract
BackgroundThyroglobulin measurement in fine-needle aspiration (FNA-Tg) is an additional diagnostic tool of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC). However, its performance as a preoperative indicator of lateral neck LNM in PTC is unclear. We evaluated the use of FNA cytology and FNA-Tg to detect neck LNM presurgery using a simple methodology, and established a cut-off value for diagnosing LNM in PTC.MethodsWe performed a retrospective cohort study based on hospital records, including 299 FNA-Tg measurements from 228 patients with PTC. The cut-off value for FNA-Tg was obtained through a receiver operating characteristic (ROC) curve analysis. The relationships between various parameters and FNA-Tg were analyzed using Spearman’s correlation.ResultsOf 299 lymph nodes (LNs) from 228 patients following surgery, 151 were malignant and 148 were benign. The median FNA-Tg levels were 414.40 ng/mL and 6.36 ng/mL in the metastatic and benign LNs, respectively. An FNA-Tg cut-off value of 28.3 ng/mL had the best diagnostic performance (93.38% sensitivity, 70.27% specificity, area under the ROC curve [AUC] 0.868) in the whole cohort. The diagnostic value performed better in the lateral neck group (level II–V, n = 163) than in the central neck group (level VI, n = 136); in the lateral neck group, the sensitivity and specificity of the FNA-Tg cut-off (16.8 ng/mL) were 96.25% and 96.36%, respectively.ConclusionsFNA-Tg is a useful technique for the diagnosis of LNM before surgery, especially in lateral neck dissection.Clinical trial registration numberChiCTR1900028547.
Highlights
Thyroglobulin measurement in fine-needle aspiration (FNA-Tg) is an additional diagnostic tool of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC)
The extent of surgery was based on the results of fine-needle aspiration cytology (FNAC) ? FNA to measure Tg levels (FNA-Tg). (1) When FNAC revealed malignant cells in the lymph nodes (LNs), cervical neck dissection was performed along with total thyroidectomy
Cervical neck dissection involved central with/without unilateral/bilateral lateral compartment dissection.[13,14] (2) When the FNA-Tg levels were higher than 100 ng/mL in cases with negative cytological findings, neck dissection was suggested in initial surgery.[14,15] (3) In patients having LNs with suspicious US features but no definite metastatic cells found in FNAC and a level of FNA-Tg lower than 100 ng/ mL, frozen section histologic analysis was only performed in cases required for it
Summary
Thyroglobulin measurement in fine-needle aspiration (FNA-Tg) is an additional diagnostic tool of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC). Its performance as a preoperative indicator of lateral neck LNM in PTC is unclear. We evaluated the use of FNA cytology and FNA-Tg to detect neck LNM presurgery using a simple methodology, and established a cut-off value for diagnosing LNM in PTC. We performed a retrospective cohort study based on hospital records, including 299 FNA-Tg measurements from 228 patients with PTC. Of 299 lymph nodes (LNs) from 228 patients following surgery, 151 were malignant and 148 were benign. An FNA-Tg cut-off value of 28.3 ng/mL had the best diagnostic performance (93.38% sensitivity, 70.27% specificity, area under the ROC curve [AUC] 0.868) in the whole cohort.
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