Hong Chae Moon, Jeong Ju Hye, Son Seung Hyun, Lee Chang-Hee, Jeong Shin Young, Lee Sang-Woo, Lee Jaetae, Ahn Byeong-Cheol
Departments of Nuclear Medicine, Kyungpook National University Hospital.
Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Medicine (Baltimore). 2019 Aug;98(31):e16461. doi: 10.1097/MD.0000000000016461.
Ultrasonography (USG)-guided fine needle aspiration (FNA) is widely used for diagnosis of lymph node (LN) metastasis in papillary thyroid cancer (PTC). However, FNA cytology sometimes shows inconclusive results. Recently, the measurement of thyroglobulin (Tg) in FNA washout fluid (aspirate-Tg) has been widely adopted, but there are some difficulties in the preparation of the sample and standardization of the procedure. Here, we examined serum Tg after FNA as a new predictive marker for LN metastasis of PTC. We performed USG-guided FNA cytology and examined aspirate-Tg in PTC patients showing suspicious metastatic LNs during follow-up. We measured baseline serum thyroid stimulating hormone (TSH), Tg, and Tg antibody levels before FNA, and serum Tg level within an hour after FNA. We defined aspirate-Tg level above 0.9 ng/mL as positive, and a 30% increase in serum Tg level after FNA compared to the baseline as elevation of serum Tg. Twenty-two patients were included in our study. Nine patients (40.9%) showed elevation of Tg level after FNA, and the mean value of Tg elevation was 24.8 ± 48.0 ng/mL. Among these 9 patients, 8 were diagnosed with PTC and 1 patient showed cellular atypia on cytopathology. All these patients showed positive aspirate-Tg. Thirteen patients (59.1%) did not show elevation of Tg level after FNA. Among these patients, 2 had PTC, 2 had cellular atypia, and 9 yielded negative results for malignancy on cytopathology. Elevation of serum Tg level after FNA might have a diagnostic role for predicting LN metastasis of PTC.
超声引导下细针穿刺抽吸活检（USG-FNA）广泛应用于诊断甲状腺乳头状癌（PTC）的淋巴结（LN）转移。然而，FNA细胞学检查有时结果不明确。近年来，FNA冲洗液中甲状腺球蛋白（Tg）的检测（抽吸液-Tg）已被广泛采用，但样本制备和操作标准化存在一些困难。在此，我们检测了FNA后的血清Tg，作为PTC淋巴结转移的一种新的预测标志物。我们对随访期间显示可疑转移性淋巴结的PTC患者进行了USG-FNA细胞学检查，并检测了抽吸液-Tg。我们在FNA前测量了基线血清促甲状腺激素（TSH）、Tg和Tg抗体水平，并在FNA后1小时内测量了血清Tg水平。我们将抽吸液-Tg水平高于0.9 ng/mL定义为阳性，将FNA后血清Tg水平较基线升高30%定义为血清Tg升高。我们的研究纳入了22例患者。9例患者（40.9%）FNA后Tg水平升高，Tg升高的平均值为24.8±48.0 ng/mL。在这9例患者中，8例被诊断为PTC，1例细胞病理学显示细胞异型性。所有这些患者的抽吸液-Tg均为阳性。13例患者（59.1%）FNA后Tg水平未升高。在这些患者中，2例患有PTC，2例有细胞异型性，9例细胞病理学恶性结果为阴性。FNA后血清Tg水平升高可能对预测PTC的淋巴结转移具有诊断作用。
