Thyroglobulin measurements in washouts of fine-needle aspiration biopsy in the monitoring of patients with differentiated thyroid carcinoma

Bakuła-Zalewska, Elwira; Żyłka, Agnieszka; Długosińska, Joanna; Musiał, Emilia; Gałczyński, Jacek; Dedecjus, Marek

doi:10.5603/ep.a2021.0077

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…23 As documented by Bakuła-Zalewska et al, who studied the role of Tg-FNAC in diagnosing lymph nodal metastases in patients with differentiated thyroid carcinoma (DTC), including both PTC and follicular thyroid carcinoma, Tg-FNAC combined with FNAC of suspicious lymph nodes in patients with DTC increased the diagnostic accuracy of FNAC (99% sensitivity and 99% specificity). 24 Another option to clarify the role of FNAC was suggested by Zhang et al 25 The authors compared FNAC and core needle biopsy The false-positive cases had a negative Tg-FNAC, but at the histological evaluation, we found another lymph node with a micrometastasis. The false-positive interpretation was due to the presence of a few cells resembling an epithelial morphology.…”

Section: Discussionmentioning

confidence: 85%

“…The authors suggested that with a sensitivity of 86.6%, Tg‐FNAC is likely to be used as an adjunct to FNAC alone 23 . As documented by Bakuła‐Zalewska et al., who studied the role of Tg‐FNAC in diagnosing lymph nodal metastases in patients with differentiated thyroid carcinoma (DTC), including both PTC and follicular thyroid carcinoma, Tg‐FNAC combined with FNAC of suspicious lymph nodes in patients with DTC increased the diagnostic accuracy of FNAC (99% sensitivity and 99% specificity) 24 …”

Section: Discussionmentioning

confidence: 94%

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Diagnostic role of FNA cytology in the evaluation of cervical lymph nodes in thyroid cancers: Combined evaluation of thyroglobulin in eluate from FNA cytology

Tralongo

Bruno

Policardo

et al. 2023

Cancer Cytopathology

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BackgroundThe presurgical evaluation of cervical lymph nodes (CLNs) in the management of thyroid malignant lesions is crucial for the extent of surgery or detection of metastases. In these last decades, fine‐needle aspiration cytology (FNAC) has been shown to have a central role in the detection of nodal thyroid metastases. It is adopted for the possibility of confirming suspected metastases either in the presurgical phase or in the follow‐up of patients after thyroidectomy. However, FNAC from CLNs can be challenging, especially in cystic lesions. In this regard, the combination of FNAC with thyroglobulin measurement in the eluate from FNAC (Tg‐FNAC) seems to increase the sensitivity of FNAC in the detection of CLN metastases. The role of FNAC and Tg‐FNAC was investigated in this series.MethodsOne hundred fifty‐three prospective cytological samples of CLNs were studied along with surgical follow‐up in the period between 2020 and 2022. Immunocytochemistry (ICC) was performed on liquid‐based cytology–stored material.ResultsOne hundred fifty‐nine enlarged CLNs included 19 central lymph nodes and 140 CLNs. Forty‐two thyroidal CLN metastases and 117 reactive lymph nodes were found. Thirty‐one CLN dissections were performed in patients with a previous diagnosis of thyroid carcinoma (mostly papillary thyroid carcinoma [PTC]), whereas 128 CLNs with a concomitant suspicious and/or malignant thyroid nodule were found. There was one false‐positive case among all the malignant histologically confirmed cases, and two of 117 reactive CLNs (1.7%) had a diagnosis of metastatic PTC. Markedly high Tg‐FNAC was found in all metastatic CLNs, including 11 cystic metastatic CLNs detected by Tg‐FNAC with a negative FNAC. ICC (including Tg, CK‐19, and LCA) recognized nine cases with low Tg‐FNAC and scant suspicious thyrocytes. Tg‐FNAC plus FNAC diagnosed 94.2% of malignancies.ConclusionsFNAC represents a valid method for the evaluation of CLNs, especially combined with ICC. Tg‐FNAC is an additional method with a useful role in FNAC.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 94%

Diagnostic role of FNA cytology in the evaluation of cervical lymph nodes in thyroid cancers: Combined evaluation of thyroglobulin in eluate from FNA cytology

Tralongo

Bruno

Policardo

et al. 2023

Cancer Cytopathology

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“…Многие авторы принимали минимальный порог ТГ ≤1 нг / мл, исходя из соображений, что в норме ТГ в ЛУ быть не должно [6,12]. Некоторые исследователи использовали ROC-анализ для выбора порогового значения ТГ при оптимальных чувствительности и специфичности [13]. Предлагалось также использовать различные пороговые значения для пациентов после тиреоидэктомии и с сохраненной ЩЖ [14].…”

Section: Discussionunclassified

Thyroglobulin measurement in the needle washout for diagnosis of lymph node metastases of differentiated thyroid cancer

Severskaya

Chebotareva

Желонкина

et al. 2023

Opuholi golovy i šei

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Introduction. Measurement of thyroglobulin (Tg) in a washout after fine-needle aspiration (FNA) is recommended for the diagnosis of metastases of differentiated thyroid cancer (DTC), but the method is not standardized and there is no recommended threshold value of Tg washout, which makes it difficult to interpret the results.Aim. To analyze Tg in the washout after FNA of lesions of different origin on the neck and to determine its optimal cutoff for the diagnosis of DTC metastases.Materials and methods. Ultrasound-guided FNA was performed in 1258 neck masses from 591 patients, 566 of them with confirmed DTC. In 1023 lesions, FNA was performed after thyroidectomy, 22 – after lobectomy, 213 – with preserved thyroid gland. The needle after FNA was washed in 1 ml of saline, in which the concentration of Tg was then examined. The level of Tg in the washout was compared with the histological (n = 522) or cytological diagnosis if no surgery was performed. The cut-off for Tg washout was determined by ROC analysis.Results. DTC lymph node metastases detected in 577 specimens. Nine specimens were obtained from metastases of thyroid cancer (TC) that does not express Tg (anaplastic TC, poorly differentiated TC, columnar-cell variant DTC), 22 – from neck metastases of other malignancy (lung cancer, mucinous soft tissues tumor, ovarian cancer, esophageal cancer, melanoma, neuroendocrine tumor), 6 – from other tumors of the neck (lymphoma, parathyroid adenoma, neurinoma). In 26 cases, the specimen was regarded as normal thyroid tissue left after thyroidectomy, 37 – postoperative seroma or granuloma, 1 – cyst of the neck, 578 – lymph node hyperplasia, 2 – sarcoidosis. The level of Tg washout from DTC metastasis and thyroid remnant significantly differed from that of non-thyroidal origin (p <0.0001). At the cut-off of 7.8 ng/ml, the sensitivity and specificity of Tg washout in the diagnosis of DTC metastases is 94 and 95 %, and at the cut-off of 20 ng/ml, 90 and 98 %, respectively. False-negative results were obtained from DTC with squamous metaplasia or sparse tumor cells in a specimen. False-positive results were obtained more often from lesions of level VI and IV compared with other localizations (8 % versus 4 %; p = 0.04). There were no differences in false positive rate in patients before and after thyroidectomy (p = 0.17), but in patients after thyroidectomy with a serum Tg >200 ng/ml, the false positive rate of Tg washout was significantly higher than that with a lower level of serum Tg (28 % versus 3 %; p = 0.0004). When comparing diagnostic performance of cytology and Tg washout, the advantage of the latter is in the diagnosis of cystic metastases, and the former is in the diagnosis of micrometastases and tumors that do not express Tg. Thyroglobulin in the washout increased the sensitivity of the cytology by 8 %. The combined use of these methods detected DTC metastases in 100 % of patients.Conclusion. Measurement of Tg in the washout is a useful addition to the cytology, increasing the diagnostic performance of the latter, mainly due to better detection of cystic metastases of DTC. The optimal suggested cut-off for Tg washout is 20 ng/mL, at which there are fewer false positives.

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“…В результате, чувствительность и специфичность для ТАБ составили 97 и 99 %; для ТАБ-ТГ -92 и 93 %; при их комбинации (ТАБ + ТАБ-ТГ) -99 % соответственно. Таким образом, сочетание ТАБ + ТАБ-ТГ увеличило чувствительность по сравнению с изолированной ТАБ или ТАБ-ТГ [9].…”

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The role of the study of the level of thyroglobulin in the washout fuid of the needle aspiration for the detection of cervical lymph node metastases in well-differentiated thyroid cancer

Gogieva,

Romanov,

Stanyakina

et al. 2023

Sib. onkol. ž.

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The study objective: to assess the diagnostic value of measuring the concentration of thyroglobulin (Tg) in the washout fluid of the fine needle aspiration (FNA) for the detection of well-differentiated thyroid cancer regional metastases.Material and Methods. The study included 64 patients with well-differentiated thyroid cancer. Ultrasound examination revealed 71 enlarged regional lymph nodes. The patients underwent simultaneous FNA cytology examination of lymph nodes and the study of Tg concentration in the washout fluid of the needle aspiration. Regional lymph node metastases were verified in 38 patients. These patients underwent surgery. Histological examination of surgical specimens was performed in 43 out of 71 cases.Results. The sensitivity, specificity, and accuracy of the FNA biopsy and the study of the concentration of thyroglobulin in the in the washout fluid of FNA were 88.5 %, 56.3 %, 76.2 % and 100 %, respectively. The rate of false-positive results of thyroid FNA biopsy was 16 %. The optimal cutoff value for FNA-Tg measurement was 4 g/ml. This made it possible to increase the sensitivity and specificity of the method to 100 %. It was found that the presence of circulating antibodies to Tg in the blood serum had no effect on the diagnostic value of FNA-Tg measurement (p=0.421). There were no statistically significant differences in the levels of thyroglobulin in the in the washout fluid of FNA between patients with Tg concentration above and below the cutoff values (3.9 [0.47; 39.9] ng/ ml vs 12.3 [0.57; 294.8] ng/ml).

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Thyroglobulin measurements in washouts of fine-needle aspiration biopsy in the monitoring of patients with differentiated thyroid carcinoma

Cited by 4 publications

References 27 publications

Diagnostic role of FNA cytology in the evaluation of cervical lymph nodes in thyroid cancers: Combined evaluation of thyroglobulin in eluate from FNA cytology

Diagnostic role of FNA cytology in the evaluation of cervical lymph nodes in thyroid cancers: Combined evaluation of thyroglobulin in eluate from FNA cytology

Thyroglobulin measurement in the needle washout for diagnosis of lymph node metastases of differentiated thyroid cancer

The role of the study of the level of thyroglobulin in the washout fuid of the needle aspiration for the detection of cervical lymph node metastases in well-differentiated thyroid cancer

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