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

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.

Surgical management of thyroid follicular neoplasms: A retrospective analysis of 128 patients

“…Risk factors such as age, gender, nodule size, serum thyroglobulin levels, US findings, molecular and genetic markers have been intensively investigated in the past for making management decisions. In the latest ATA guidelines, a more accurate US assessment was done in order to classify thyroid nodules [3,7,13]. Therefore, some immunocytochemical and genetic markers may be useful in order to discriminate benign adenomas from carcinomas, but these markers need to be validated in larger series [2,[14][15][16][17][18][19][20][21].…”

“…With the extensive use of thyroid ultrasonography (US) and US guided fine needle aspiration cytology (FNAC) in thyroid pathologies, we encounter 15-30% of cases of "follicular neoplasm/ suspicious for follicular neoplasm" lesions (FN) [1][2][3][4]. However, we also know that preoperative US features, molecular markers, or intraoperative consultation [5] are not accurate enough to predict malignancy.…”

Thyroglobulin Wash Testing in the Surveillance of Patients with Thyroid Carcinoma: Proposal for a Reflex Test

“…It is used for both lymph nodes and thyroid bed nodules. The recommendations to add TG-W testing to FNA cytology are based on strong evidence of increased sensitivity of combined testing over cytology alone [2,6,8,10,12,14]. Positive FNA cytology in cervical lymph nodes at the time of initial investigation for DTC will necessitate the extension of the surgery to include the involved group of lymph nodes [1].…”

Capabilities of single-photon emission computed tomography combined with computed tomography in diagnosis of neck masses

“…Цитологическое заключение при ТАПБ под контролем УЗИ узловых образований щитовидной железы и внеорганных образо-ваний шеи имеет низкую чувствительность (40-50%), что не даёт возможности цитоло-гу уверенно определить структуру исследу-емого образования [8,9] Современные методы лучевой визуа-лизации имеют большое значение в диф-ференциальной диагностике объёмных образований шеи, позволяя определить размеры, характер образования, указать точную локализацию и дать оценку их то-пографоанатомических взаимоотношений с окружающими структурами. Однако для получения полноценной диагностической картины необходимо сочетание несколь-ких лучевых методов исследования, что увеличивает время диагностического про-цесса [10].…”