Véliz Jesús, Brantes Sergio, Ramos Claudia, Aguayo Jaime, Cáceres Edith, Herrera Mónica, Barber Ana, Barría Manuel, Wohllk Nelson
Sección Endocrinología, Servicio de Medicina, Hospital del Salvador, Santiago, Chile.
Rev Med Chil. 2008 Sep;136(9):1107-12. Epub 2008 Nov 12.
During the detection of neck recurrence in patients with Papillary Thyroid Carcinoma (PTC), sometimes it is difficult to distinguish metastatic from inflammatory neck lymph nodes. The measurement of serum thyroglobulin (sTg) under thyroid hormone suppression therapy the presence of serum thyroglobulin antibodies (sAbTg), the diagnostic whole body scan and cytology can give false negative results. Measurement of thyroglobulin in the washout fluid from fine-needle aspiration biopsy (FNAB) of suspicious neck lymph nodes could improve the diagnostic accuracy.
To evaluate the usefulness of detecting Tg in lymph nodes (LTg) suspicious by ultrasonography (US) and compare it to cytology.
Between the years 2004 and 2007 we prospectively studied 30 patients with PTC and cervical US findings of suspicious recurrence. LTg was assayed in US guided FNAB used for cytology.
Sixteen out of 30 patients underwent surgery using as selective criteria an LTg higher than sTg or a positive cytology. Surgery confirmed the presence of metastasis in all 15 patients with positive LTg (8 with positive cytology) and in 1 patient with negative LTg and positive cytology (a case with undifferentiated thyroid cancer). The sensitivity was 93.7% for LTg and 56.2% for cytology. We identified by LTg 3 of 6 patients with undetectable sTg and positive sAbTg.
The presence of LTg showed a higher sensitivity than cytology for the detection of cervical lymph node metastasis. This method is useful even in the presence of sAbTg.
在检测甲状腺乳头状癌（PTC）患者的颈部复发时，有时很难区分转移性颈部淋巴结和炎性颈部淋巴结。甲状腺激素抑制治疗下血清甲状腺球蛋白（sTg）的测量、血清甲状腺球蛋白抗体（sAbTg）的存在、诊断性全身扫描和细胞学检查可能会给出假阴性结果。对可疑颈部淋巴结细针穿刺活检（FNAB）冲洗液中的甲状腺球蛋白进行测量可提高诊断准确性。
评估检测超声（US）可疑的淋巴结中Tg（LTg）的实用性，并将其与细胞学检查进行比较。
在2004年至2007年期间，我们前瞻性地研究了30例PTC患者，其颈部超声检查发现可疑复发。在用于细胞学检查的超声引导下FNAB中检测LTg。
30例患者中有16例接受了手术，选择标准为LTg高于sTg或细胞学检查阳性。手术证实所有15例LTg阳性患者（8例细胞学检查阳性）和1例LTg阴性但细胞学检查阳性的患者（1例未分化甲状腺癌病例）存在转移。LTg的敏感性为93.7%，细胞学检查的敏感性为56.2%。我们通过LTg识别出6例sTg检测不到且sAbTg阳性患者中的3例。
LTg的存在对检测颈部淋巴结转移的敏感性高于细胞学检查。即使存在sAbTg，该方法也有用。
