Thyroglobulin measurement in fine-needle aspirate washouts: The criteria for neck node dissection for patients with thyroid cancer

Min Jung Kim, Eun Kyung Kim, Byung Moon Kim, Jin Young Kwak, Eun Jig Lee, Cheong Soo Park, Woong Youn Cheong, Ki Hyun Nam

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Background: Several studies report that detection of thyroglobulin (Tg) in fine-needle aspiration (FNA) biopsy washout fluid from lymph nodes identifies recurrences/metastases of differentiated papillary thyroid cancer (DPTC) in the neck with higher sensitivity and specificity than fine-needle aspiration cytology (FNAC). However, the diagnostic FNA-Tg cutoff values have not yet been established. Objective: To determine an appropriate diagnostic threshold value for Tg levels in FNA washout fluid in patients with neck node metastases or recurrences of DPTC. Design: We performed ultrasound (US)-guided FNAC and measured Tg levels in FNA washout fluid (FNA-Tg). Final diagnoses were confirmed by histological examination of excised specimens or by follow-up examinations for at least 24 months. Patients: A total of 168 ultrasonographically detected lymph nodes from 168 patients with DPTC were included. Measurements: In comparison with FNAC, we evaluated diagnostic sensitivity, specificity and accuracy of metastasis detection according to several predetermined threshold levels: 1, 10, 100 ng/ml, mean+2SD of node-negative patients, and FNA-Tg/serum-Tg > 1. Results: The diagnostic sensitivity was lowest at 77.3% for FNAC alone. The lower FNA-Tg threshold levels showed higher diagnostic sensitivity whereas the higher FNA-Tg showed higher specificity. In addition to the FNAC results, FNA-Tg levels showed 95.0% sensitivity, 81.6% specificity, 92.6% in positive predictive value (PPV) and 87.0% in negative predictive value (NPV) with the threshold of FNA-Tg level at 10 ng/ml, serum-Tg or mean+2SD of FNA-Tg measured in node-negative patients. The diagnostic accuracy of FNA-Tg was higher in neck node recurrences after thyroid surgery than in the metastasis of patients waiting for surgery. Conclusion: FNA-Tg measurement as well as FNAC should be performed either before or after surgery to evaluate neck node metastases or recurrences in patients with differentiated thyroid carcinomas. We recommend that the threshold values for FNA-Tg levels should be > 10 ng/ml if the serum-Tg level or the mean+2SD in node-negative patients is not available for reference.

Original languageEnglish
Pages (from-to)145-151
Number of pages7
JournalClinical Endocrinology
Volume70
Issue number1
DOIs
Publication statusPublished - 2009 Jan 1

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Neck Dissection
Thyroglobulin
Fine Needle Biopsy
Thyroid Neoplasms
Needles
Cell Biology
Neoplasm Metastasis
Recurrence
Neck
Sensitivity and Specificity
Lymph Nodes
Serum

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

@article{7201f6295e6e4f77aa433864c272753a,
title = "Thyroglobulin measurement in fine-needle aspirate washouts: The criteria for neck node dissection for patients with thyroid cancer",
abstract = "Background: Several studies report that detection of thyroglobulin (Tg) in fine-needle aspiration (FNA) biopsy washout fluid from lymph nodes identifies recurrences/metastases of differentiated papillary thyroid cancer (DPTC) in the neck with higher sensitivity and specificity than fine-needle aspiration cytology (FNAC). However, the diagnostic FNA-Tg cutoff values have not yet been established. Objective: To determine an appropriate diagnostic threshold value for Tg levels in FNA washout fluid in patients with neck node metastases or recurrences of DPTC. Design: We performed ultrasound (US)-guided FNAC and measured Tg levels in FNA washout fluid (FNA-Tg). Final diagnoses were confirmed by histological examination of excised specimens or by follow-up examinations for at least 24 months. Patients: A total of 168 ultrasonographically detected lymph nodes from 168 patients with DPTC were included. Measurements: In comparison with FNAC, we evaluated diagnostic sensitivity, specificity and accuracy of metastasis detection according to several predetermined threshold levels: 1, 10, 100 ng/ml, mean+2SD of node-negative patients, and FNA-Tg/serum-Tg > 1. Results: The diagnostic sensitivity was lowest at 77.3{\%} for FNAC alone. The lower FNA-Tg threshold levels showed higher diagnostic sensitivity whereas the higher FNA-Tg showed higher specificity. In addition to the FNAC results, FNA-Tg levels showed 95.0{\%} sensitivity, 81.6{\%} specificity, 92.6{\%} in positive predictive value (PPV) and 87.0{\%} in negative predictive value (NPV) with the threshold of FNA-Tg level at 10 ng/ml, serum-Tg or mean+2SD of FNA-Tg measured in node-negative patients. The diagnostic accuracy of FNA-Tg was higher in neck node recurrences after thyroid surgery than in the metastasis of patients waiting for surgery. Conclusion: FNA-Tg measurement as well as FNAC should be performed either before or after surgery to evaluate neck node metastases or recurrences in patients with differentiated thyroid carcinomas. We recommend that the threshold values for FNA-Tg levels should be > 10 ng/ml if the serum-Tg level or the mean+2SD in node-negative patients is not available for reference.",
author = "Kim, {Min Jung} and Kim, {Eun Kyung} and Kim, {Byung Moon} and Kwak, {Jin Young} and Lee, {Eun Jig} and Park, {Cheong Soo} and Cheong, {Woong Youn} and Nam, {Ki Hyun}",
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Thyroglobulin measurement in fine-needle aspirate washouts : The criteria for neck node dissection for patients with thyroid cancer. / Kim, Min Jung; Kim, Eun Kyung; Kim, Byung Moon; Kwak, Jin Young; Lee, Eun Jig; Park, Cheong Soo; Cheong, Woong Youn; Nam, Ki Hyun.

In: Clinical Endocrinology, Vol. 70, No. 1, 01.01.2009, p. 145-151.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Thyroglobulin measurement in fine-needle aspirate washouts

T2 - The criteria for neck node dissection for patients with thyroid cancer

AU - Kim, Min Jung

AU - Kim, Eun Kyung

AU - Kim, Byung Moon

AU - Kwak, Jin Young

AU - Lee, Eun Jig

AU - Park, Cheong Soo

AU - Cheong, Woong Youn

AU - Nam, Ki Hyun

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Background: Several studies report that detection of thyroglobulin (Tg) in fine-needle aspiration (FNA) biopsy washout fluid from lymph nodes identifies recurrences/metastases of differentiated papillary thyroid cancer (DPTC) in the neck with higher sensitivity and specificity than fine-needle aspiration cytology (FNAC). However, the diagnostic FNA-Tg cutoff values have not yet been established. Objective: To determine an appropriate diagnostic threshold value for Tg levels in FNA washout fluid in patients with neck node metastases or recurrences of DPTC. Design: We performed ultrasound (US)-guided FNAC and measured Tg levels in FNA washout fluid (FNA-Tg). Final diagnoses were confirmed by histological examination of excised specimens or by follow-up examinations for at least 24 months. Patients: A total of 168 ultrasonographically detected lymph nodes from 168 patients with DPTC were included. Measurements: In comparison with FNAC, we evaluated diagnostic sensitivity, specificity and accuracy of metastasis detection according to several predetermined threshold levels: 1, 10, 100 ng/ml, mean+2SD of node-negative patients, and FNA-Tg/serum-Tg > 1. Results: The diagnostic sensitivity was lowest at 77.3% for FNAC alone. The lower FNA-Tg threshold levels showed higher diagnostic sensitivity whereas the higher FNA-Tg showed higher specificity. In addition to the FNAC results, FNA-Tg levels showed 95.0% sensitivity, 81.6% specificity, 92.6% in positive predictive value (PPV) and 87.0% in negative predictive value (NPV) with the threshold of FNA-Tg level at 10 ng/ml, serum-Tg or mean+2SD of FNA-Tg measured in node-negative patients. The diagnostic accuracy of FNA-Tg was higher in neck node recurrences after thyroid surgery than in the metastasis of patients waiting for surgery. Conclusion: FNA-Tg measurement as well as FNAC should be performed either before or after surgery to evaluate neck node metastases or recurrences in patients with differentiated thyroid carcinomas. We recommend that the threshold values for FNA-Tg levels should be > 10 ng/ml if the serum-Tg level or the mean+2SD in node-negative patients is not available for reference.

AB - Background: Several studies report that detection of thyroglobulin (Tg) in fine-needle aspiration (FNA) biopsy washout fluid from lymph nodes identifies recurrences/metastases of differentiated papillary thyroid cancer (DPTC) in the neck with higher sensitivity and specificity than fine-needle aspiration cytology (FNAC). However, the diagnostic FNA-Tg cutoff values have not yet been established. Objective: To determine an appropriate diagnostic threshold value for Tg levels in FNA washout fluid in patients with neck node metastases or recurrences of DPTC. Design: We performed ultrasound (US)-guided FNAC and measured Tg levels in FNA washout fluid (FNA-Tg). Final diagnoses were confirmed by histological examination of excised specimens or by follow-up examinations for at least 24 months. Patients: A total of 168 ultrasonographically detected lymph nodes from 168 patients with DPTC were included. Measurements: In comparison with FNAC, we evaluated diagnostic sensitivity, specificity and accuracy of metastasis detection according to several predetermined threshold levels: 1, 10, 100 ng/ml, mean+2SD of node-negative patients, and FNA-Tg/serum-Tg > 1. Results: The diagnostic sensitivity was lowest at 77.3% for FNAC alone. The lower FNA-Tg threshold levels showed higher diagnostic sensitivity whereas the higher FNA-Tg showed higher specificity. In addition to the FNAC results, FNA-Tg levels showed 95.0% sensitivity, 81.6% specificity, 92.6% in positive predictive value (PPV) and 87.0% in negative predictive value (NPV) with the threshold of FNA-Tg level at 10 ng/ml, serum-Tg or mean+2SD of FNA-Tg measured in node-negative patients. The diagnostic accuracy of FNA-Tg was higher in neck node recurrences after thyroid surgery than in the metastasis of patients waiting for surgery. Conclusion: FNA-Tg measurement as well as FNAC should be performed either before or after surgery to evaluate neck node metastases or recurrences in patients with differentiated thyroid carcinomas. We recommend that the threshold values for FNA-Tg levels should be > 10 ng/ml if the serum-Tg level or the mean+2SD in node-negative patients is not available for reference.

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