Duval Marta Amaro da Silveira, Zanella André Borsatto, Cristo Ana Patrícia, Faccin Carlo Sasso, Graudenz Marcia Silva, Maia Ana Luiza
Thyroid Unit, Endocrine Division, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Eur Thyroid J. 2017 Nov;6(6):292-297. doi: 10.1159/000479682. Epub 2017 Sep 6.
Thyroglobulin measurements in the washout of fine needle aspiration (FNA-Tg) are an excellent tool to detect lymph node (LN) metastases of differentiated thyroid carcinoma (DTC). Nevertheless, how to define the best cutoffs and the influence of potential confounders are still being discussed.
To evaluate the accuracy of FNA-Tg measurement to detect DTC metastases and the influence of thyroid status and anti-thyroglobulin antibodies (TgAb).
One hundred thirty-eight patients with DTC and suspicious cervical LN were included. Patients underwent ultrasound (US)-guided FNA for cytological examination and FNA-Tg measurements. Final diagnoses were confirmed by histological examination or clinical and US follow-up for at least 1 year.
Data from 119 subjects with suspicious LN were evaluated. The median value of FNA-Tg in patients with metastatic LN ( = 65) was 3,263.0 ng/mL (838.55-12,507.5), while patients without LN metastasis ( = 54) showed levels of 0.2 ng/mL (0.2-0.2). According to the ROC curve analysis, the best cutoff value to predict metastasis was 4.41 ng/mL for FNA-Tg, with a sensitivity of 98% and specificity of 96%. There were no differences in the median of FNA-Tg measurements between those on (TSH 0.16 mUI/mL) and those off levothyroxine (TSH 99.41 mUI/mL) therapy (47.94 vs. 581.15 ng/mL, respectively; = 0.79). Interestingly, the values of FNA-Tg in patients with LN metastasis ( = 65) did not differ between patients with positive and those with negative TgAb (88.8 vs. 3,263.0 ng/mL, respectively; = 0.57).
US-guided FNA-Tg proved to be a useful examination in the follow-up of patients with DTC, independently of TSH status and the presence of TgAb.
细针穿刺洗脱液中的甲状腺球蛋白测量值（FNA-Tg）是检测分化型甲状腺癌（DTC）淋巴结（LN）转移的一项出色工具。然而，如何定义最佳临界值以及潜在混杂因素的影响仍在讨论之中。
评估FNA-Tg测量在检测DTC转移方面的准确性以及甲状腺状态和抗甲状腺球蛋白抗体（TgAb）的影响。
纳入138例患有DTC且颈部LN可疑的患者。患者接受超声（US）引导下的FNA进行细胞学检查和FNA-Tg测量。最终诊断通过组织学检查或临床及超声随访至少1年得以证实。
对119例LN可疑患者的数据进行了评估。LN转移患者（n = 65）的FNA-Tg中位数为3263.0 ng/mL（838.55 - 12507.5），而无LN转移的患者（n = 54）其水平为0.2 ng/mL（0.2 - 0.2）。根据ROC曲线分析，预测转移的FNA-Tg最佳临界值为4.41 ng/mL，敏感性为98%，特异性为96%。接受左甲状腺素治疗（促甲状腺激素[TSH] 0.16 mU/L）和未接受该治疗（TSH 99.41 mU/L）的患者FNA-Tg测量中位数无差异（分别为47.94和581.15 ng/mL；P = 0.79）。有趣的是，LN转移患者（n = 65）中，TgAb阳性和阴性患者的FNA-Tg值无差异（分别为88.8和3263.0 ng/mL；P = 0.57）。
超声引导下的FNA-Tg被证明是DTC患者随访中的一项有用检查，与TSH状态和TgAb的存在无关。
