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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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 -
[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. doi: 10.3322/caac.21492 [2] 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[J]. Thyroid, 2016, 26(1): 1-133. doi: 10.1089/thy.2015.0020 [3] Ito Y, Fukushima M, Tomoda C, et al. Prognosis of patients with papillary thyroid carcinoma having clinically apparent metastasis to the lateral compartment[J]. Endocr J, 2009, 56(6): 759-66. doi: 10.1507/endocrj.K09E-025 [4] Kim DW, Choo HJ, Lee YJ, et al. Sonographic features of cervical lymph nodes after thyroidectomy for papillary thyroid carcinoma [J]. J Ultrasound Med, 2013, 32(7): 1173-80. doi: 10.7863/ultra.32.7.1173 [5] Wu MH, Shen WT, Gosnell J, et al. Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer[J]. Head Neck, 2015, 37(9): 1336-43. doi: 10.1002/hed.23747 [6] Cracchiolo JR, Wong RJ. Management of the lateral neck in well differentiated thyroid cancer[J]. Eur J Surg Oncol, 2018, 44(3): 332-7. doi: 10.1016/j.ejso.2017.06.004 [7] Xu YX, Wu DP, Wu WT, et al. Diagnostic value of cytology, thyroglobulin, and combination of them in fine-needle aspiration of metastatic lymph nodes in patients with differentiated thyroid cancer: a systematic review and network meta-analysis[J]. Medicine, 2019, 98(45): e17859. doi: 10.1097/MD.0000000000017859 [8] Leenhardt L, Erdogan MF, Hegedus L, et al. 2013 European thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer[J]. Eur Thyroid J, 2013, 2(3): 147-59. doi: 10.1159/000354537 [9] Boi F, Baghino G, Atzeni F, et al. The diagnostic value for differentiated thyroid carcinoma metastases of thyroglobulin (tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-tg antibodies[J]. J Clin Endocrinol Metab, 2006, 91(4): 1364-9. doi: 10.1210/jc.2005-1705 [10] Zhu XH, Zhou JN, Qian YY, et al. Diagnostic values of thyroglobulin in lymph node fine- needle aspiration washout: a systematic review and meta-analysis diagnostic values of FNA-Tg [J]. Endocr J, 2020, 67(2): 113-23. doi: 10.1507/endocrj.EJ18-0558 [11] Grani G, Fumarola A. Thyroglobulin in lymph node fine- needle aspiration washout: a systematic review and meta- analysis of diagnostic accuracy[J]. J Clin Endocrinol Metab, 2014, 99(6): 1970-82. doi: 10.1210/jc.2014-1098 [12] Zhao H, Wang Y, Wang MJ, et al. Influence of presence/absence of thyroid gland on the cutoff value for thyroglobulin in lymph-node aspiration to detect metastatic papillary thyroid carcinoma[J]. BMC Cancer, 2017, 17(1): 296. doi: 10.1186/s12885-017-3296-3 [13] Duval MADS, Zanella AB, Cristo AP, et al. Impact of serum TSH and anti-thyroglobulin antibody levels on lymph node fine- needle aspiration thyroglobulin measurements in differentiated thyroid cancer patients[J]. Eur Thyroid J, 2017, 6(6): 292-7. doi: 10.1159/000479682 [14] Netzel BC, Grebe SKG, Carranza Leon BG, et al. Thyroglobulin (tg) testing revisited: tg assays, TgAb assays, and correlation of results with clinical outcomes[J]. J Clin Endocrinol Metab, 2015, 100(8): E1074-83. doi: 10.1210/jc.2015-1967 [15] Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013[J]. JAMA, 2017, 317(13): 1338-48. doi: 10.1001/jama.2017.2719 [16] Gharib H, Papini E, Garber JR, et al. American association of clinical endocrinologists, American college of endocrinology, and associazione medici endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: 2016 update[J]. Endocr Pract, 2016, 22(5): 622-39. [17] Jeon MJ, Kim WG, Jang EK, et al. Thyroglobulin level in fine-needle aspirates for preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: two different cutoff values according to serum thyroglobulin level[J]. Thyroid, 2015, 25(4): 410-6. doi: 10.1089/thy.2014.0544 [18] Wang JH, Jiang XF, Xiao GZ, et al. Excellent diagnostic performance of FNA-Tg in detecting lymph nodes metastases from papillary thyroid cancer[J]. Future Oncol, 2020, 16(33): 2735-46. doi: 10.2217/fon-2020-0213 [19] Shin HJ, Lee HS, Kim EK, et al. A study on serum antithyroglobulin antibodies interference in thyroglobulin measurement in fine-needle aspiration for diagnosing lymph node metastasis in postoper-ative patients[J]. PLoS One, 2015, 10(6): e0131096. doi: 10.1371/journal.pone.0131096 [20] Moon JH, Kim YI, Lim JA, et al. Thyroglobulin in washout fluid from lymph node fine-needle aspiration biopsy in papillary thyroid cancer: large-scale validation of the cutoff value to determine malignancy and evaluation of discrepant results[J]. J Clin Endocrinol Metab, 2013, 98(3): 1061-8. doi: 10.1210/jc.2012-3291 [21] Cappelli C, Pirola I, De Martino E, et al. Thyroglobulin measurement in fine- needle aspiration biopsy of metastatic lymph nodes after rhTSH stimulation[J]. Head Neck, 2013, 35(1): E21-3. [22] Giovanella L, Suriano S, Ceriani L, et al. Undetectable thyroglobulin in patients with differentiated thyroid carcinoma and residual radioiodine uptake on a postablation whole-body scan[J]. Clin Nucl Med, 2011, 36(2): 109-12. doi: 10.1097/RLU.0b013e318203bb84 [23] Chung J, Kim EK, Lim H, et al. Optimal indication of thyroglobulin measurement in fine- needle aspiration for detecting lateral metastatic lymph nodes in patients with papillary thyroid carcinoma [J]. Head Neck, 2014, 36(6): 795-801. doi: 10.1002/hed.23371 [24] Randolph GW, Duh QY, Heller KS, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension[J]. Thyroid, 2012, 22(11): 1144-52. doi: 10.1089/thy.2012.0043 [25] Barbosa MP, Momesso D, Bulzico DA, et al. Metastatic lymph node characteristics as predictors of recurrence/persistence in the neck and distant metastases in differentiated thyroid cancer[J]. Arch Endocrinol Metab, 2017, 61(6): 584-9. doi: 10.1590/2359-3997000000307 [26] Layfield LJ. Fine-needle aspiration in the diagnosis of head and neck lesions: a review and discussion of problems in differential diagnosis[J]. Diagn Cytopathol, 2007, 35(12): 798-805. doi: 10.1002/dc.20769 [27] Alpert EH, Wenig BM, Dewey EH, et al. Size distribution of metastatic lymph nodes with extranodal extension in patients with papillary thyroid cancer: a pilot study[J]. Thyroid, 2015, 25(2): 238-41. doi: 10.1089/thy.2014.0392 [28] Siddiqui S, White MG, Antic T, et al. Clinical and pathologic predictors of lymph node metastasis and recurrence in papillary thyroid microcarcinoma[J]. Thyroid, 2016, 26(6): 807-15. doi: 10.1089/thy.2015.0429 [29] Mauri G, Cova L, Ierace T, et al. Treatment of metastatic lymph nodes in the neck from papillary thyroid carcinoma with percutaneous laser ablation[J]. Cardiovasc Intervent Radiol, 2016, 39(7): 1023-30. doi: 10.1007/s00270-016-1313-6