Diagnostic efficacy of thyroglobulin in fine-needle aspirate fluid for cervical lateral lymph node metastasis of differentiated thyroid cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Sheng , LIU Tingting ,  ZHANG Zaizhong , DENG Lin , LIN Zhiqing , ZHA Quanping

Department of General Surgery, Fuzong Clinical Medical College of Fujian Medical University, 900th Hospital of the Joint Logistics Support Force (900th Hospital, Joint Logistics Support Force, Chinese People’s Liberation Army; Dongfang Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University), Fuzhou 350025, P. R. China;

Corresponding author：

ZHANG Zaizhong, Email: 2740150389@qq.com

Keywords：

differentiated thyroid cancer; cervical lateral lymph node metastasis; lymph node short-axis diameter; thyroglobulin; cytology pathology

DOI：

10.7507/1007-9424.202411081

Video：

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Objective To evaluate the diagnostic efficacy of thyroglobulin in fine-needle aspirate fluid (FNA-Tg) for detecting cervical lateral lymph node metastases (LLNM) in differentiated thyroid cancer (DTC). Methods The clinical data of DTC patients who underwent (selective) cervical lateral lymph node dissection at the 900th Hospital of the Joint Logistics Support Force from February 2021 to November 2023 were retrospectively analyzed. The significance level (α) was set at 0.05. Results According to the inclusion and exclusion criteria, a total of 155 patients with 179 lymph nodes were included, among which 49 lymph nodes were not metastatic and 130 were metastatic. The results of the integral analysis showed that the area under the receiver operating characteristic curve (AUC) of FNA-Tg for distinguishing cervical LLNM in the patients with DTC was superior to that of fine needle aspiration cytology (FNAC). The AUCs (95% confidence intervals) were [0.973 (0.950, 0.995) and 0.778 (0.708, 0.849), P<0.05], respectively, and the AUC (95% confidence interval) of the combination of the two was higher [0.978 (0.959, 0.997)]. The optimal diagnostic threshold of FNA-Tg was determined to be 16.45 μg/L or FNA-Tg/serum thyroglobulin >1. After stratification based on the size of the lymph nodes, a paired analysis of the two methods (FNA-Tg and FNAC) showed that the diagnostic efficiency of FNA-Tg was significantly higher than that of FNAC only when the short diameter of the lymph node was ≤0.8 cm (P<0.05), and its diagnostic efficiency was the best [0.955 (0.919, 0.992)], and there was no additional benefit from the combination of the two. Conclusions The results of this study suggest that FNA-Tg shows a good diagnostic efficacy for cervical LLNM in patients with DTC, especially has an obvious advantage for small lymph nodes with a short-axis diameter of lymph node ≤0.8 cm. Its optimal diagnostic threshold is 16.45 μg/L or FNA-Tg/serum thyroglobulin >1.

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2.	王权, 杨珂璐, 李杨, 等. 分化型甲状腺癌研究的主题挖掘及引文科学的知识域可视化. 中华内分泌外科杂志, 2021, 15(4): 387-393.
3.	So YK, Kim MJ, Kim S, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg, 2018, 50: 94-103. doi: 10.1016/j.ijsu.2017.12.029.
4.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
5.	Pacini F, Gasperi M, Fugazzola L, et al. Testicular function in patients with differentiated thyroid carcinoma treated with radioiodine. J Nucl Med, 1994, 35(9): 1418-1122.
6.	Xiao J, Meng S, Zhang M, et al. Optimal method for detecting cervical lymph node metastasis from papillary thyroid cancer. Endocrine, 2023, 79(2): 342-348.
7.	Wang Y, Duan Y, Zhou M, et al. The diagnostic value of thyroglobulin in fine-needle aspiration of metastatic lymph nodes in patients with papillary thyroid cancer and its influential factors. Surg Oncol, 2021, 39: 101666. doi: 10.1016/j.suronc.2021.101666.
8.	Willms A, Melder J, Hoffmann MA, et al. The significance of FNAC in diagnosing differentiated thyroid cancer and the discrepancy between theory and practice—A multi-centre study. Nuklearmedizin, 2020, 59(3): 248-255.
9.	徐震纲, 刘绍严. 分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版). 中国实用外科杂志, 2017, 37(9): 985-991.
10.	Jiang HJ, Hsiao PJ. Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review. Kaohsiung J Med Sci, 2020, 36(4): 236-243.
11.	Wang J, Jiang X, Xiao G, et al. Excellent diagnostic performance of FNA-Tg in detecting lymph nodes metastases from papillary thyroid cancer. Future Oncol, 2020, 16(33): 2735-2746.
12.	Al-Hilli Z, Strajina V, McKenzie TJ, et al. Thyroglobulin Measurement in Fine-Needle Aspiration Improves the Diagnosis of Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma. Ann Surg Oncol, 2017, 24(3): 739-744.
13.	Liu RB, Zhou DL, Xu BH, et al. Comparison of the diagnostic performances of US-guided fine needle aspiration cytology and thyroglobulin measurement for lymph node metastases in patients with differentiated thyroid carcinoma: a meta-analysis. Eur Radiol, 2021, 31(5): 2903-2914.
14.	Luster M, Aktolun C, Amendoeira I, et al. EuroPean PersPective on 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: Proceedings of an Interactive International Symposium. Thyroid, 2019, 29(1): 7-26.
15.	van den Brekel MW. Lymph node metastases: CT and MRI. Eur J Radiol, 2000, 33(3): 230-238.
16.	Li Q, Liu Y, Zhang G, et al. Diagnostic strategy of fine needle aspiration cytology of cystic cervical lymph node metastasis from papillary thyroid carcinoma. Diagn Cytopathol, 2022, 50(7): 350-356.
17.	Costante G, Filetti S. Diagnosis: Thyroglobulin in fine-needle aspirates-a clue to metastasis?. Nat Rev Endocrinol, 2009, 5(5): 249-250.
18.	周乐, 张广, 张大奇, 等. 细针穿刺活检及洗脱液检测在甲状腺癌颈淋巴结清扫决策中的应用研究. 中国实用外科杂志, 2017, 37(9): 1002-1006.
19.	Giovanella L, Bongiovanni M, Trimboli P. Diagnostic value of thyroglobulin assay in cervical lymph node fine-needle aspirations for metastatic differentiated thyroid cancer. Curr Opin Oncol, 2013, 25(1): 6-13.
20.	Pigal A, Draganova-Tacheva R, Solomides CC, et al. Thyroglobulin wash testing in the surveillance of patients with thyroid carcinoma: proposal for a reflex test. Acta Cytol, 2013, 57(6): 545-549.
21.	杨汶士, 张艳, 张凤凤, 等. 细针穿刺洗脱液测定甲状腺球蛋白和细针穿刺细胞学诊断甲状腺乳头状癌颈部淋巴结转移的Meta分析. 肿瘤研究与临床, 2022, 34(2): 137-141.

1. Jung CK, Bychkov A, Kakudo K. Update from the 2022 World Health Organization classification of thyroid tumors: A standardized diagnostic approach. Endocrinol Metab (Seoul), 2022, 37(5): 703-718.
2. 王权, 杨珂璐, 李杨, 等. 分化型甲状腺癌研究的主题挖掘及引文科学的知识域可视化. 中华内分泌外科杂志, 2021, 15(4): 387-393.
3. So YK, Kim MJ, Kim S, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis for prevalence, risk factors, and location. Int J Surg, 2018, 50: 94-103. doi: 10.1016/j.ijsu.2017.12.029.
4. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1): 1-133.
5. Pacini F, Gasperi M, Fugazzola L, et al. Testicular function in patients with differentiated thyroid carcinoma treated with radioiodine. J Nucl Med, 1994, 35(9): 1418-1122.
6. Xiao J, Meng S, Zhang M, et al. Optimal method for detecting cervical lymph node metastasis from papillary thyroid cancer. Endocrine, 2023, 79(2): 342-348.
7. Wang Y, Duan Y, Zhou M, et al. The diagnostic value of thyroglobulin in fine-needle aspiration of metastatic lymph nodes in patients with papillary thyroid cancer and its influential factors. Surg Oncol, 2021, 39: 101666. doi: 10.1016/j.suronc.2021.101666.
8. Willms A, Melder J, Hoffmann MA, et al. The significance of FNAC in diagnosing differentiated thyroid cancer and the discrepancy between theory and practice—A multi-centre study. Nuklearmedizin, 2020, 59(3): 248-255.
9. 徐震纲, 刘绍严. 分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版). 中国实用外科杂志, 2017, 37(9): 985-991.
10. Jiang HJ, Hsiao PJ. Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review. Kaohsiung J Med Sci, 2020, 36(4): 236-243.
11. Wang J, Jiang X, Xiao G, et al. Excellent diagnostic performance of FNA-Tg in detecting lymph nodes metastases from papillary thyroid cancer. Future Oncol, 2020, 16(33): 2735-2746.
12. Al-Hilli Z, Strajina V, McKenzie TJ, et al. Thyroglobulin Measurement in Fine-Needle Aspiration Improves the Diagnosis of Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma. Ann Surg Oncol, 2017, 24(3): 739-744.
13. Liu RB, Zhou DL, Xu BH, et al. Comparison of the diagnostic performances of US-guided fine needle aspiration cytology and thyroglobulin measurement for lymph node metastases in patients with differentiated thyroid carcinoma: a meta-analysis. Eur Radiol, 2021, 31(5): 2903-2914.
14. Luster M, Aktolun C, Amendoeira I, et al. EuroPean PersPective on 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: Proceedings of an Interactive International Symposium. Thyroid, 2019, 29(1): 7-26.
15. van den Brekel MW. Lymph node metastases: CT and MRI. Eur J Radiol, 2000, 33(3): 230-238.
16. Li Q, Liu Y, Zhang G, et al. Diagnostic strategy of fine needle aspiration cytology of cystic cervical lymph node metastasis from papillary thyroid carcinoma. Diagn Cytopathol, 2022, 50(7): 350-356.
17. Costante G, Filetti S. Diagnosis: Thyroglobulin in fine-needle aspirates-a clue to metastasis?. Nat Rev Endocrinol, 2009, 5(5): 249-250.
18. 周乐, 张广, 张大奇, 等. 细针穿刺活检及洗脱液检测在甲状腺癌颈淋巴结清扫决策中的应用研究. 中国实用外科杂志, 2017, 37(9): 1002-1006.
19. Giovanella L, Bongiovanni M, Trimboli P. Diagnostic value of thyroglobulin assay in cervical lymph node fine-needle aspirations for metastatic differentiated thyroid cancer. Curr Opin Oncol, 2013, 25(1): 6-13.
20. Pigal A, Draganova-Tacheva R, Solomides CC, et al. Thyroglobulin wash testing in the surveillance of patients with thyroid carcinoma: proposal for a reflex test. Acta Cytol, 2013, 57(6): 545-549.
21. 杨汶士, 张艳, 张凤凤, 等. 细针穿刺洗脱液测定甲状腺球蛋白和细针穿刺细胞学诊断甲状腺乳头状癌颈部淋巴结转移的Meta分析. 肿瘤研究与临床, 2022, 34(2): 137-141.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Latest ArticlesDiagnostic efficacy of thyroglobulin in fine-needle aspirate fluid for cervical lateral lymph node metastasis of differentiated thyroid cancer

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