细针穿刺细胞学检查在甲状腺癌颈部淋巴结评估中的诊断作用：洗脱液中甲状腺球蛋白的联合评估。
Diagnostic role of FNA cytology in the evaluation of cervical lymph nodes in thyroid cancers: Combined evaluation of thyroglobulin in eluate from FNA cytology.
机构信息
Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy.
Division of Endocrinology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Rome, Italy.
出版信息
Cancer Cytopathol. 2023 Nov;131(11):693-700. doi: 10.1002/cncy.22745. Epub 2023 Jul 31.
BACKGROUND
The presurgical evaluation of cervical lymph nodes (CLNs) in the management of thyroid malignant lesions is crucial for the extent of surgery or detection of metastases. In these last decades, fine-needle aspiration cytology (FNAC) has been shown to have a central role in the detection of nodal thyroid metastases. It is adopted for the possibility of confirming suspected metastases either in the presurgical phase or in the follow-up of patients after thyroidectomy. However, FNAC from CLNs can be challenging, especially in cystic lesions. In this regard, the combination of FNAC with thyroglobulin measurement in the eluate from FNAC (Tg-FNAC) seems to increase the sensitivity of FNAC in the detection of CLN metastases. The role of FNAC and Tg-FNAC was investigated in this series.
METHODS
One hundred fifty-three prospective cytological samples of CLNs were studied along with surgical follow-up in the period between 2020 and 2022. Immunocytochemistry (ICC) was performed on liquid-based cytology-stored material.
RESULTS
One hundred fifty-nine enlarged CLNs included 19 central lymph nodes and 140 CLNs. Forty-two thyroidal CLN metastases and 117 reactive lymph nodes were found. Thirty-one CLN dissections were performed in patients with a previous diagnosis of thyroid carcinoma (mostly papillary thyroid carcinoma [PTC]), whereas 128 CLNs with a concomitant suspicious and/or malignant thyroid nodule were found. There was one false-positive case among all the malignant histologically confirmed cases, and two of 117 reactive CLNs (1.7%) had a diagnosis of metastatic PTC. Markedly high Tg-FNAC was found in all metastatic CLNs, including 11 cystic metastatic CLNs detected by Tg-FNAC with a negative FNAC. ICC (including Tg, CK-19, and LCA) recognized nine cases with low Tg-FNAC and scant suspicious thyrocytes. Tg-FNAC plus FNAC diagnosed 94.2% of malignancies.
CONCLUSIONS
FNAC represents a valid method for the evaluation of CLNs, especially combined with ICC. Tg-FNAC is an additional method with a useful role in FNAC.
背景
在甲状腺恶性病变的管理中，颈部淋巴结（CLN）的术前评估对于手术范围或转移灶的检测至关重要。在过去的几十年中，细针穿刺细胞学（FNAC）已被证明在检测淋巴结甲状腺转移方面具有核心作用。它被用于在术前阶段或甲状腺切除术后患者的随访中，确认可疑转移灶的可能性。然而，CLN 的 FNAC 可能具有挑战性，尤其是在囊性病变中。在这方面，FNAC 与 FNAC 洗脱液中甲状腺球蛋白测量（Tg-FNAC）相结合，似乎可以提高 FNAC 检测 CLN 转移的敏感性。本系列研究了 FNAC 和 Tg-FNAC 的作用。
方法
对 2020 年至 2022 年间的 153 例前瞻性 CLN 细胞学样本进行了研究，并进行了手术随访。对液基细胞学储存材料进行免疫细胞化学（ICC）检测。
结果
共纳入 159 个肿大的 CLN，其中中央淋巴结 19 个，CLN140 个。发现 42 例甲状腺 CLN 转移和 117 例反应性淋巴结。31 例 CLN 切除术患者既往诊断为甲状腺癌（主要为甲状腺乳头状癌[PTC]），而 128 例 CLN 伴有可疑和/或恶性甲状腺结节。所有经组织学证实的恶性病例中均有 1 例假阳性病例，117 例反应性 CLN 中有 2 例（1.7%）诊断为转移性 PTC。所有转移性 CLN 的 Tg-FNAC 均明显升高，包括 11 例 Tg-FNAC 检测为阴性的囊性转移性 CLN。ICC（包括 Tg、CK-19 和 LCA）识别出 9 例 Tg-FNAC 低且可疑甲状腺细胞稀少的病例。Tg-FNAC 联合 FNAC 诊断出 94.2%的恶性肿瘤。
结论
FNAC 是评估 CLN 的有效方法，尤其是与 ICC 联合使用。Tg-FNAC 是一种额外的方法，在 FNAC 中具有有用的作用。
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