Kim Kwangsoon, Bae Ja Seong, Kim Jeong Soo
Department of Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea.
Gland Surg. 2021 Sep;10(9):2686-2694. doi: 10.21037/gs-21-366.
Thyroglobulin (Tg) level of fine needle aspiration (FNA) washout fluid (FNA-Tg) is useful to detect cervical lymph node (LN) metastasis in patients with papillary thyroid cancer (PTC). The objective of this study was to determine appropriate cutoff values of serum Tg (S-Tg) and FNA-Tg levels for diagnosis of lateral neck LN metastasis and investigate their diagnostic performance.
A total of 169 patients with PTC who underwent modified radical neck dissection (mRND) were retrospectively reviewed at Seoul St. Mary's Hospital (Seoul, Korea) from December 2011 to September 2019. Diagnostic performance of FNA-Tg, Tg ratio (FNA-Tg level/S-Tg level), and FNA-Tg combined with Tg ratio was evaluated by correlation with FNA cytology results.
FNA-Tg level ≥20 ng/mL exhibited 86.6% sensitivity, 66.7% specificity, and 81.7% accuracy. Tg ratio ≥3 exhibited lower sensitivity but higher specificity (82.7% and 73.8%, respectively) than FNA-Tg level ≥20 ng/mL. FNA-Tg level ≥20 ng/mL combined with Tg ratio ≥3 had 81.9% sensitivity, 80.5% accuracy, and an integrated area under the curve (iAUC) of 0.790.
Measurement of FNA-Tg level increases preoperative diagnostic accuracy for the detection of metastatic LNs in patients with PTC. Diagnostic accuracy is higher using a 20 ng/mL FNA-Tg cutoff level. Tg ratio is also valuable and FNA-Tg combined with Tg ratio shows promise.
细针穿刺（FNA）冲洗液中的甲状腺球蛋白（Tg）水平（FNA-Tg）有助于检测甲状腺乳头状癌（PTC）患者的颈部淋巴结（LN）转移。本研究的目的是确定血清Tg（S-Tg）和FNA-Tg水平用于诊断侧颈LN转移的合适临界值，并研究它们的诊断性能。
回顾性分析了2011年12月至2019年9月在韩国首尔圣玛丽医院接受改良根治性颈清扫术（mRND）的169例PTC患者。通过与FNA细胞学结果的相关性评估FNA-Tg、Tg比值（FNA-Tg水平/S-Tg水平）以及FNA-Tg联合Tg比值的诊断性能。
FNA-Tg水平≥20 ng/mL时，敏感性为86.6%，特异性为66.7%，准确性为81.7%。Tg比值≥3的敏感性低于FNA-Tg水平≥20 ng/mL，但特异性更高（分别为82.7%和73.8%）。FNA-Tg水平≥20 ng/mL联合Tg比值≥3时，敏感性为81.9%，准确性为80.5%，曲线下综合面积（iAUC）为0.790。
测量FNA-Tg水平可提高PTC患者术前检测转移性LN的诊断准确性。使用20 ng/mL的FNA-Tg临界值时诊断准确性更高。Tg比值也有价值，FNA-Tg联合Tg比值显示出前景。
