Mikosiński Sławomir, Pomorski Lech, Oszukowska Lidia, Makarewicz Jacek, Adamczewski Zbigniew, Sporny Stanisław, Lewiński Andrzej
Department of Endocrinology and Metabolic Diseases, Unit of Nuclear Medicine and Oncological Endocrinology, Medical University, Lodz.
Endokrynol Pol. 2006 Jul-Aug;57(4):392-5.
Recurrent differentiated thyroid cancer generally occurs first in the neck. Ultrasound is sensitive in detecting enlarged cervical lymph nodes but is not specific enough. Ultrasound-guided fine-needle biopsy increases the specificity but still may fail to detect a recurrence of the disease in the cystic metastatic lymph nodes. The aim of the study was to estimate the value of Tg concentration in the needle washout after fine-needle aspiration of suspicious lymph nodes.
The 105 patients studied had presented one or more enlarged suspicious cervical lymph nodes. All had undergone total thyroidectomy and (131)I ablative therapy. Serum thyroglobulin (Tg) concentration was within the 0.15-711.5 ng/ml range (mean 22.24 ng/ml) and Tg recovery range 94-100%. The positive Tg washout concentration cut-off value was established as equal to the mean plus two standard deviations of the Tg washout concentration of patients with negative cytology.
Lymph node involvement was diagnosed by cytology in 15 patients and in 28 lymph nodes. Positive Tg washout concentration was found in 22 patients and in 48 lymph nodes. All the lymph nodes which turned out to have positive cytology had a positive Tg washout concentration. All lymph nodes with positive cytology were positive in pathology. Seven patients and 20 lymph nodes with negative cytology were positive in the Tg washout concentration test. All but one patients and all but two lymph nodes with a positive Tg washout concentration had positive pathology.
复发性分化型甲状腺癌通常首先发生于颈部。超声在检测颈部肿大淋巴结方面较为敏感，但特异性不足。超声引导下细针穿刺活检可提高特异性，但仍可能无法检测出囊性转移性淋巴结中的疾病复发情况。本研究的目的是评估可疑淋巴结细针穿刺后针冲洗液中甲状腺球蛋白（Tg）浓度的价值。
研究的105例患者存在一个或多个肿大的可疑颈部淋巴结。所有患者均接受了甲状腺全切除术及（131）I消融治疗。血清甲状腺球蛋白（Tg）浓度在0.15 - 711.5 ng/ml范围内（平均22.24 ng/ml），Tg回收率在94 - 100%之间。将阳性Tg冲洗液浓度临界值设定为等于细胞学检查阴性患者的Tg冲洗液浓度平均值加两个标准差。
15例患者及28个淋巴结经细胞学检查确诊有淋巴结受累。22例患者及48个淋巴结检测到阳性Tg冲洗液浓度。所有细胞学检查呈阳性的淋巴结其Tg冲洗液浓度均为阳性。所有细胞学检查呈阳性的淋巴结病理检查也均为阳性。7例患者及2０个细胞学检查阴性的淋巴结在Tg冲洗液浓度检测中呈阳性。除1例患者和2个淋巴结外，所有Tg冲洗液浓度呈阳性的患者和淋巴结病理检查均为阳性。
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