Relationship between and FNA-Tg and the size of metastatic lymph nodes from papillary thyroid carcinoma
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摘要:
目的 探究甲状腺乳头状癌颈部转移性淋巴结大小与穿刺洗脱液甲状腺球蛋白（FNA-Tg）测值的关系。 方法 连续收集2018年4月~2019年1月上海交通大学医学院附属瑞金医院的96例疑似甲状腺乳头状癌颈部淋巴结转移或复发患者的临床资料，共纳入疾病相关的颈部淋巴结136枚，以穿刺细胞学结果或石蜡病理为金标准，将颈部淋巴结分为良性和恶性。对患者的颈部可疑淋巴结进行超声评估，测量淋巴结在最大切面上的长轴和短轴，对淋巴结进行穿刺细胞学检查和FNA-Tg测定，FNA-Tg样本使用ECL分析仪(Cobase 602，瑞士罗氏)和ELEXSYS TG Ⅱ试剂盒测定Tg数值。所有患者穿刺前2周内均完成甲状腺功能的血清学检测，分析甲状腺乳头状癌转移性淋巴结大小与FNA-Tg测值之间的关系。 结果 136枚可疑淋巴结中，89枚（65.44%）和47枚（34.56%）分别诊断为转移性淋巴结和良性淋巴结。转移性淋巴结FNA-Tg的测值水平高于非转移性淋巴结（中位数631.550 ng/mL vs 0.056 ng/mL，P < 0.001），FNA-Tg诊断转移性淋巴结的截值为2.71 ng/mL，FNA-Tg/sTg诊断转移性淋巴结的截值为6.50 ng/mL，淋巴结大小与FNA-Tg的测值及诊断结果无相关性（P>0.05）。 结论 甲状腺乳头状癌转移性淋巴结的FNA-Tg测值结果显著高于非转移性淋巴结，淋巴结的大小本身不影响FNA-Tg的测值及诊断结果。 Abstract:Objective To analyze the relationship between and the value of FNA-Tg and the size of metastatic lymph nodes from papillary thyroid carcinoma (PTC). Methods The clinical data of 96 patients with suspected cervical lymph node metastasis or recurrence of thyroid papillary carcinoma in Ruijin Hospital affiliated to Medical College of Shanghai Jiaotong University from April 2018 to January 2019 were collected. A total of 136 suspicious cervical lymph nodes from 96 PTC patients were prospectively included, and the lymph nodes were divided into benign and malignant according to the results of aspiration cytology or paraffin pathology. The long and short axes of each lymph node on the largest section were measured by ultrasound, each suspected lymph node was aspirated with a 22-gauge needle, then FNA-Tg was measured. ECL analyzer (Cobas E602, Roche, Switzerland) and ELEXSYS TG Ⅱ kit were used to determine the Tg value of FNA-Tg samples. Serological examination of thyroid function was performed in all patients within 2 weeks before FNA. The relationship between metastatic lymph node size and FNA-Tg in PTC patients was analyzed. Results Among the 136 lymph nodes, 89 (65.44%) were diagnosed as metastatic lymph nodes and 47 (34.56%) were benign. The level of FNA-Tg in metastatic lymph nodes was significantly higher than that in non-metastatic lymph nodes (median 631.550 ng/mL vs 0.056 ng/mL). The cut-off value of FNA-Tg and FNA-Tg/sTg in the diagnosis of metastatic lymph nodes was 2.71 ng/mL and 6.50 ng/mL separately. There was no significant correlation between the size of lymph nodes and FNA-Tg (P>0.05). Conclusion The FNA-Tg level of metastatic lymph nodes in PTC patients is significantly higher than that of non-metastatic lymph nodes. The size of lymph nodes alone can not predict the level of FNA-Tg. -
Key words:
- thyroglobulin /
- thyroid carcinoma /
- lymph node /
- ultrasonography
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图 1 FNA-Tg测值诊断淋巴结良恶性的ROC曲线
Figure 1. ROC curve of FNA-Tg measurement in the diagnosis of benign and malignant lymph nodes.
图 2 FNA-Tg/sTg值诊断淋巴结良恶性的ROC曲线
Figure 2. ROC curve of FNA-Tg/sTg value in the diagnosis of benign and malignant lymph nodes.
表 1 患者临床特征与细胞病理学结果相关性
Table 1. Correlation between clinical characteristics and cytopathological results of patients
Index Metastatic lymph node Benign lymph node P Age (year, Mean±SD) 37.00±12.28 44.67±13.12 0.009 Gender (Male/Female, n) 30/39 12/16 0.955 FT3 (pmol/L, Mean±SD) 4.34±0.63 4.17±0.74 0.323 FT4 (pmol/L, Mean±SD) 15.13±3.71 15.19±3.27 0.725 TSH [μU/mL, M(range)] 1.01（0.01-27.33） 1.50（0.00-4.75） 0.906 TgAb [U/mL, M(range)] 2.42（0.56-4232） 2.81（0.86-494.18） 0.407 Tg [ng/mL, M(range)] 8.73（0.04-5356.00） 4.77（0.04-65.42） 0.019 FNA-Tg [ng/mL, M(range)] 631.550（0.04-116880.00） 0.056（0.04-17560.00） < 0.001 
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