Achille Gaetano, Garrisi Vito M, Russo Sabino, Guastamacchia Edoardo, Giagulli Vito A, Schirosi Laura, Daniele Antonella, Tufaro Antonio, Cafagna Vito, Centrone Marilena, Simone Giovanni, Abbate Ines, Triggiani Vincenzo
Otorhinolaringology Unit, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, 70124 Bari. Italy.
Clinical and Experimental Pathology Laboratory, National Cancer Research Centre, Istituto Tumori "Giovanni Paolo II", Bari. Italy.
Endocr Metab Immune Disord Drug Targets. 2017;17(3):213-218. doi: 10.2174/1871530317666170531092501.
Differentiated thyroid carcinomas (DTCs) account for about 1% of all human malignancies. Cervical lymph nodes metastases and recurrences in the thyroid bed frequently occur. Furthermore, about 10-15% of patients develop distant metastases. Therefore, patients must undergo life-long follow-up.
The aim of this study was to evaluate the usefulness of Thyroglobulin measurement in FNAB washout (FNAB-Tg) in the detection of local metastasis in patients affected by or evaluated for thyroid cancer.
In a 3-year period, a total of 83 consecutive patients coming to our attention at the Ear-Nose-Throat (ENT) Outpatients Service of the National Cancer Research Center "Istituto Tumori Giovanni Paolo II" of Bari, Italy, because of the finding of one or more cervical lymph node(s), were enrolled in the study. After collection of the cytological specimen, the needle used for performing FNAB was then washed in 1 ml of normal saline. 89 FNAB washouts were collected from the same number of lymph nodes and subsequently investigated for Thyroglobulin levels using a sequential chemiluminescent-immunometric assay.
Comparing the cytological or, when performed, histological diagnoses with the results of FNAB-Tg, we found that in 24 cases of lymph node metastases from PTC (19 lymph nodes from patients at the first diagnoses and 5 lymph nodes from PTC patients in follow up) the mean level of Thyroglobulin was 1840.11 ng/ml; range: <0,2 to 11440 ng/ml. In the group of PTC patients (27 lymph nodes) with lymph nodes negative for metastatic involvement at cytology (i.e. no lymph node recurrence at follow-up), as well as in the cases of subjects without PTC and submitted to FNAB because of the appearance of lymph node(s) classified as reactive at cytology (37 lymph nodes), FNAB-Tg was lower than or equal to 0.2 ng/ml. As expected, the Thyroglobulin level was not detectable (< 0.2 ng/ml) also in a lymph node FNAB from a case of anaplastic thyroid carcinoma.
In our study, FNAB-Tg was not detectable in all node negative patients showing, when considering together all the lymph node metastases, a 96% sensitivity and 100% specificity.
分化型甲状腺癌（DTC）约占人类所有恶性肿瘤的1%。甲状腺床的颈部淋巴结转移和复发很常见。此外，约10 - 15%的患者会发生远处转移。因此，患者必须接受终身随访。
本研究旨在评估细针穿刺抽吸活检冲洗液中甲状腺球蛋白测量值（FNAB - Tg）在检测甲状腺癌患者或疑似甲状腺癌患者局部转移中的作用。
在3年时间里，意大利巴里国家癌症研究中心“乔瓦尼·保罗二世肿瘤研究所”耳鼻喉科门诊共连续纳入83例因发现一个或多个颈部淋巴结而引起我们关注的患者。采集细胞学标本后，用于细针穿刺抽吸活检的针在1毫升生理盐水中冲洗。从相同数量的淋巴结中收集了89份细针穿刺抽吸活检冲洗液，随后使用连续化学发光免疫分析法检测甲状腺球蛋白水平。
将细胞学诊断结果（若进行了组织学诊断，则为组织学诊断结果）与FNAB - Tg检测结果进行比较，我们发现，在24例乳头状甲状腺癌（PTC）淋巴结转移病例中（19例为初诊患者的淋巴结，5例为PTC随访患者的淋巴结），甲状腺球蛋白平均水平为1840.11纳克/毫升；范围：<0.2至11440纳克/毫升。在细胞学检查显示淋巴结无转移累及的PTC患者组（27个淋巴结）中（即随访时无淋巴结复发），以及在因细胞学检查将淋巴结分类为反应性而接受细针穿刺抽吸活检的非PTC患者病例中（37个淋巴结），FNAB - Tg低于或等于0.2纳克/毫升。不出所料，在一例未分化甲状腺癌患者的淋巴结细针穿刺抽吸活检中，甲状腺球蛋白水平也未检测到（<0.2纳克/毫升）。
在我们的研究中，所有淋巴结阴性患者的FNAB - Tg均未检测到，综合所有淋巴结转移情况来看，其敏感性为96%，特异性为100%。
