Sun Jingjing, Li Peipei, Chen Xiao, Yu Qiujie, Li Li
Department of Ultrasound Hebei General Hospital Shijiazhuang China.
School of Graduate Hebei Medical University Shijiazhuang China.
Laryngoscope Investig Otolaryngol. 2021 Dec 24;7(1):274-282. doi: 10.1002/lio2.717. eCollection 2022 Feb.
Papillary thyroid carcinoma is treated in China mostly with surgery, including total ablation, lobectomy, and lobe and isthmus resection. Therefore, whether thyroid status affects the FNA-Tg cutoff value in the diagnosis of cervical lymph node metastasis deserves our attention. In addition, we investigated the influence of serum Tg, TSH, and TgAb on the accuracy of using FNA-Tg for diagnosis.
Our retrospective analysis included 189 suspected cervical lymph nodes, and we determined whether the cutoff value of FNA-Tg was affected by thyroid status, sTg, sTSH, and sTgAb.
In thyroid present cases, the optimal cutoff value of FNA-Tg was 2.3 ng/ml (sensitivity 96.2%, specificity 100%), and in the thyroid absent cases, the optimal cutoff value of FNA-Tg was 0.7 ng/ml (sensitivity 97.6%, specificity 96.0%). Although serum Tg, TSH, and TgAb were weakly correlated with FNA-Tg values, they did not affect the diagnostic performance of the optimal cutoff value of FNA-Tg according to thyroid status.
The optimal cutoff value of FNA-Tg should be selected according to the thyroid status (2.3 ng/ml for thyroid present cases and 0.7 ng/ml for thyroid absent cases) to ensure the efficient diagnosis of cervical metastatic lymph nodes of papillary thyroid carcinoma. It was determined that sTg, sTSH, and sTg-Ab cannot influence the diagnostic performance of FNA-Tg. The combination method of FNA-Tg and FNAC is the most optimal choice for the diagnosis of lymph nodes metastasis.
在中国，甲状腺乳头状癌主要通过手术治疗，包括全消融、叶切除术以及叶和峡部切除术。因此，甲状腺状态是否会影响细针穿刺抽吸活检甲状腺球蛋白（FNA-Tg）在诊断颈部淋巴结转移中的临界值值得我们关注。此外，我们还研究了血清甲状腺球蛋白（Tg）、促甲状腺激素（TSH）和甲状腺球蛋白抗体（TgAb）对使用FNA-Tg进行诊断准确性的影响。
我们的回顾性分析纳入了189个疑似颈部淋巴结，并确定FNA-Tg的临界值是否受甲状腺状态、血清Tg（sTg）、血清TSH（sTSH）和血清TgAb的影响。
在甲状腺存在的病例中，FNA-Tg的最佳临界值为2.3 ng/ml（敏感性96.2%，特异性100%）；在甲状腺缺失的病例中，FNA-Tg的最佳临界值为0.7 ng/ml（敏感性97.6%，特异性96.0%）。尽管血清Tg、TSH和TgAb与FNA-Tg值呈弱相关，但它们并不影响根据甲状腺状态确定的FNA-Tg最佳临界值的诊断性能。
应根据甲状腺状态选择FNA-Tg的最佳临界值（甲状腺存在病例为2.3 ng/ml，甲状腺缺失病例为0.7 ng/ml），以确保对甲状腺乳头状癌颈部转移淋巴结进行有效诊断。已确定sTg、sTSH和sTg-Ab不会影响FNA-Tg的诊断性能。FNA-Tg与细针穿刺抽吸活检（FNAC）的联合方法是诊断淋巴结转移的最佳选择。
