Importance of Hormones and Proteins Determination in the Material Obtained by Fine-Needle Aspiration

Abstract

Kratak sadr`aj: Vi{e od pola veka iskustva sa aspira cijskom punkcijom nodoznih promena u {titastoj `lezdi utvrdilo je ovaj postupak kao zlatni standard u ispitivanju tiroidne nodozne bolesti. Iako su osetljivost, specifi~nost, pouzdanost i reproducibilnost dokazano visoke, ovaj postupak ipak u skoro petini slu~ajeva ne mo`e jednozna~no da odgovori da li je ispitivana promena benigne ili maligne prirode. Mnogo brojni poku{aji da se postupak popravi doveli su do znaajnog pobolj{anja vrednosti njime dobijenih nalaza. Po red rafiniranja tehnika citopatolo{kih pretraga, dokaziva nje ili odre|ivanje hormona, proteina i drugih supstanci u ma te rijalu dobijenom aspiracijom tankom iglom danas pred stavlja najve}i doprinos u pobolj{anju dijagnosti~ke vrednosti postup ka. Ovi belezi se danas u najve}em broju centara prate u aspiratima nodoznih promena u {titastoj `lezdi ali i okolnih limfnih nodusa kako bi se sa ve}om sigurno{}u ocenile vrsta promene, obim i stepen pro{irenosti, {to je od zna~aja u pripremi terapijskih postupaka ali i za ocenu rezidualne bolesti posle primenjenog le~enja.Klju~ne re~i: aspiracija tankom iglom, tireoglobulin, BRAF mutacija, diferentovani karcinom tireoidee, tiroidna nodozna bolest Hormones and proteins in FNA fluidNodular changes of the thyroid structure are a frequent occurrence; they are found by palpation in around 4-7% of adults. Thyroid nodules are more frequent in female and aged individuals. Incidence of newly discovered nodules increases especially after proceeding to neck and thyroid ultrasonography; thyroid nodules are found by ultrasonography in over one third of the overall population, while some series show a presence of nodular change in the thyroid gland in over 50% of adults (1). Such a large number of nodular changes is a great economic burden on public health and an important psychological burden Summary: More than a half century of experience with aspi ration punch of nodal changes in the thyroid gland has confir med this procedure as a golden standard in the exami nation of thyroid nodal disease. Although sensitivity, spe cificity, reliability and reproducibility are incontestably high, this procedure cannot give a simple answer on whether the change examined is benign or malignant. Numerous attempts to im prove the procedure resulted in considerably advanced findings. Besides refining the cytopathologic examination techniques, confirmation or determination of hormones, proteins and other substances in the material obtained by fine-needle aspiration are actually the greatest contribution to improvement the of procedure's diagnostic value. These markers are actually followed, in most medical centers, in aspirates of thyroid nodal changes but also surrounding lymph nodes in order to evaluate with greater certainty the type, volume and spread; this is important to establish treatment procedures and to evaluate the residual disease after accomplishing the treatment.Keywords: fine-needle aspiration, thyroglobulin, BRAF mutation, differentiated thyroid carcinoma, thyroid noda...

Diagnosis of Thyroid Disease: Principles and Problems

“…MTC produces calcitonin and carcinoembryonic antigen (CEA), but calcitonin is specific for MTC. Tumor dedif ferentiation is associated with a fall of CT and increasing CEA, and this is a bad sign (49). Diagnosis is based on the calcitonin measurement, and calcitonin measurement is recommended in all subjects with thyroid nodules (43).…”

Measuring Thyroglobulin Concentrations in Patients with Differentiated Thyroid Carcinoma

“…It seems that values for Tg measured by RIA tests correspond more closely to physiological values, as both free Tg and Tg complexed with TgAb are detected (15). The principle of RIA tests is competitive binding by polyclonal antibodies, which have greater possibilities of recognizing epitopes exposed on Tg molecules bound to TgAb (9,(11)(12)(13). The method of disrupting binding of the TgAb-Tg complex to antibody in IMA tests could be twofold: stearic inhibition or masking of the epitope that recognizes the monoclonal antibody in the diagnostic kit, but there are no experimental data for this mechanistic concept (9,11,66).…”

“…Epitope mapping on the Tg molecule has shown the existence of six different antigenic regions to which different thyroglobulin-specific antibodies (TgAb) can bind (9, 10), most probably due to differences in Tg molecules secreted from malignantly changed thyroid cells (9,(11)(12)(13).…”