分化型甲状腺癌手术后立即进行首次甲状腺球蛋白测定在转移灶诊断中的价值评估。

An evaluation of the value of first thyroglobulin determination in the diagnostics of metastases immediately following differentiated thyroid carcinoma surgery.

作者信息

Makarewicz Jacek, Adamczewski Zbigniew, Rutkowski Antoni, Mikosiński Sławomir, Knapska-Kucharska Małgorzata, Gonerska-Szadkowska Anna, Oszukowska Lidia, Karwowska Anzelmina, Lewiński Andrzej

机构信息

Department of Endocrinology and Metabolic Diseases, Unit of Nuclear Medicine and Oncological Endocrinology, Medical University, Lodz.

出版信息

Endokrynol Pol. 2006 Jul-Aug;57(4):370-3.

PMID:17006838

Abstract

INTRODUCTION

Evaluation of the differential value of the first thyroglobulin (Tg) concentration, measured after thyroidectomy (Tx) but before thyroid remnant ablation, in patients with differentiated thyroid carcinoma (DTC) as a marker of either metastases or residual cancer (M).

MATERIAL AND METHODS

Data from 517 patients with DTC after Tx, with follow-up > 1.5 year were analysed retrospectively. Patients in whom either the course of the disease was unclear or interference in the Tg test was possible (a-TgAb [+], Tg recovery < 80%) were excluded from the study. Finally, the data from 247 patients were evaluated (age: 14-79 years; 223 women, 24 men). The results of TSH, thyroid radioiodine uptake (T(up24)), thyroid remnant volume (V) and Tg in patients with diagnosed M (group M1; n = 35) were compared with the same parameters in patients with remission > 1.5 year (group M0; n = 212). The area under the ROC curve was calculated. The clinical decision limit of Tg level to be suggestive of metastases was determined by means of efficiency curve.

RESULTS

Groups M0 and M1 did not differ from each other with respect to TSH concentration (median 49.7 mIU/l vs 44.3; p = 0.16) or thyroid remnant volume (1.4 vs 1.1 ml; p = 0.79). However, they did differ with respect to T(up24) (7.6 vs 3.2%; p = 0.01) and Tg (4.5 vs 96.7 ng/ml; p = 0.000000). Area under ROC for Tg was 0.78 +/- 0.05 (mean +/- s.e.m.). The decision limit of Tg for suspected M was determined at 38.1 ng/ml, Tg sensitivity was 0.57 (95%CI 0.39-0.74) and specificity 0.96 (95%CI 0.92-0.98).

CONCLUSIONS

First thyroglobulin concentration, determined after thyroidectomy but before other treatment, is higher in patients with metastatic DTC than in patients without such metastases. This indicates that Tg level may be used as an early marker of either residual or metastatic DTC (even if thyroid remnants are present).

摘要

引言

评估分化型甲状腺癌（DTC）患者甲状腺切除术后（Tx）但在甲状腺残余组织消融术前测得的首个甲状腺球蛋白（Tg）浓度作为转移或残留癌（M）标志物的鉴别价值。

材料与方法

回顾性分析517例Tx术后DTC患者的数据，随访时间>1.5年。疾病病程不明或可能干扰Tg检测的患者（抗Tg抗体[+]，Tg回收率<80%）被排除在研究之外。最终，对247例患者的数据进行评估（年龄：14 - 79岁；女性223例，男性24例）。将确诊为M的患者（M1组；n = 35）的患者的促甲状腺激素（TSH）、甲状腺放射性碘摄取率（T(up24)）、甲状腺残余体积（V）和Tg结果与缓解>1.5年的患者（M0组；n = 212）的相同参数进行比较。计算ROC曲线下面积。通过效能曲线确定提示转移的Tg水平的临床决策界值。

结果

M0组和M1组在TSH浓度（中位数49.7 mIU/l对44.3；p = 0.16）或甲状腺残余体积（1.4对1.1 ml；p = 0.79）方面无差异。然而，在T(up24)（7.6对3.2%；p = 0.01）和Tg（4.5对96.7 ng/ml；p = 0.000000）方面存在差异。Tg的ROC曲线下面积为0.78±0.05（均值±标准误）。疑似M的Tg决策界值确定为38.1 ng/ml，Tg敏感性为0.57（95%CI 0.39 - 0.74），特异性为0.96（95%CI 0.92 - 0.98）。