Inagaki Yozo, Sakamoto Koji, Inoue Yasuhiro, Imanishi Yorihisa, Tomita Toshiki, Shinden Seiichi, Ozawa Hiroyuki, Fujii Ryoichi, Shigetomi Seiji, Watabe Takahisa, Yamada Hiroyuki, Ogawa Kaoru
Department of Otorhinolaryngology, Head and Neck Surgery, Keio University, Tokyo.
Nihon Jibiinkoka Gakkai Kaiho. 2011 Dec;114(12):912-6. doi: 10.3950/jibiinkoka.114.912.
Combining ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and fine-needle aspiration cytology (FNAC) usually results in the best preoperative diagnosis of cervical masses, including neoplasms. This may not be true, however, especially in occult papillary thyroid carcinoma (PTC) associated with single cystic cervical lymph node metastasis. We assessed the role of thyroglobulin measurement in FNA fluid (FNATg) in differentially diagnosing cystic cervical mass lesions, including PTC cystic lymph node metastasis.
We reviewed the records of 17 subjects with cervical cystic masses undergoing both FNATg measurement and surgery. FNA was done under ultrasonographic guidance. We also measured FNATg concentrations from extrathyroid lesions, consisting of cystic cervical lymph node metastases and benign cystic lesions.
Pathological diagnosis involved 5 PTC lymph node metastases, 3 lateral cervical cysts, 7 thyroglossal duct cysts, and 2 squamous cell carcinoma (lung and oropharynx) lymph node metastases. FNATg of PTC lymph node metastasis was much higher than the reference range of blood serum thyroglobulin, although much lower for the lateral cervical cyst detection threshold. FNAC and FNATg measurement are thought to be mutually complementary in the differential diagnosis of PTC cystic lymph node metastasis.
High concentrations of FNATg in a cystic cervical mass is considered specific to PTC lymph node metastasis, indicating its usefulness in distinguish PTC cystic metastasis from other cystic lesions. Including FNATg measurement with FNAC may thus improve preoperative diagnosis accuracy without additionally stressing subjects with PTC cystic lymph node metastasis.
联合使用超声、计算机断层扫描（CT）、磁共振成像（MRI）和细针穿刺细胞学检查（FNAC）通常能对包括肿瘤在内的颈部肿块做出最佳的术前诊断。然而，情况可能并非总是如此，尤其是在隐匿性乳头状甲状腺癌（PTC）伴有单个囊性颈部淋巴结转移的情况下。我们评估了细针穿刺抽吸液中甲状腺球蛋白测量值（FNATg）在鉴别诊断包括PTC囊性淋巴结转移在内的囊性颈部肿块病变中的作用。
我们回顾了17例接受FNATg测量和手术的颈部囊性肿块患者的记录。在超声引导下进行细针穿刺抽吸。我们还测量了甲状腺外病变的FNATg浓度，这些病变包括囊性颈部淋巴结转移和良性囊性病变。
病理诊断包括5例PTC淋巴结转移、3例颈部外侧囊肿、7例甲状舌管囊肿和2例鳞状细胞癌（肺和口咽）淋巴结转移。PTC淋巴结转移的FNATg远高于血清甲状腺球蛋白的参考范围，尽管低于颈部外侧囊肿的检测阈值。在PTC囊性淋巴结转移的鉴别诊断中，FNAC和FNATg测量被认为是相互补充的。
颈部囊性肿块中高浓度的FNATg被认为是PTC淋巴结转移所特有的，表明其在区分PTC囊性转移与其他囊性病变方面的有用性。因此，将FNATg测量与FNAC相结合可以提高术前诊断的准确性，而不会给PTC囊性淋巴结转移的患者增加额外负担。
