Liu Junsong, Wang Rui, Xu Chongwen, Zhao Ruimin, Wang Shiyang, Zhao Qian, Li Honghui, Yao Xiaobao, Gao Rui, Bai Yanxia, Zhang Shaoqiang
Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, People's Republic of China.
Sci Rep. 2025 Apr 23;15(1):14057. doi: 10.1038/s41598-025-99169-4.
The detection of thyroglobulin in lymph node (LN) fine needle aspirates (FNA-Tg) is an effective supplement to ultrasound and fine needle aspiration cytology (FNAC) in diagnosis of cervical LN metastases for patients with papillary thyroid carcinoma (PTC). However, there is no unique cutoff value of FNA-Tg in practice. We aimed to determine the optimal cutoff of FNA-Tg and evaluate the interfering factors of FNA-Tg. A serial of 405 lateral cervical LN samples from 317 patients with PTC were analyzed retrospectively. Receiver operating characteristic (ROC) curve was used to determine the optimal cutoff of FNA-Tg. The factors that impact FNA-Tg were evaluated. Serum Tg, serum thyroglobulin antibody (TgAb) and serum thyroid stimulating hormone (TSH) level, and thyroid status did not differ between the malignant and benign LN groups. The median FNA-Tg was 3.81 ng/mL (0.16-33.40 ng/mL) in LNs without metastasis and 310.32 ng/mL (124.41-500.00 ng/mL) in LNs with metastasis, and the differences reached statistical significance (P < 0.01). The optimal cutoff of FNA-Tg was 36.22 ng/mL, and the values of area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) was 0.88, 0.89, 0.75, 0.91 and 0.71, respectively. The diagnostic accuracy of FNA-Tg cutoff of 36.22ng/mL was 85%. When FNAC and the present FNA-Tg cutoff of 36.22 ng/mL were combined together, the diagnostic sensitivity, specificity, PPV, NPV and diagnostic accuracy was 0.96, 0.75, 0.92, 0.87 and 91%, respectively. FNA-Tg improves the diagnostic efficacy of FNAC for PTC lateral cervical LN metastasis, and the optimal cutoff value of FNA-Tg was 36.22 ng/mL. FNA-Tg was affected by LN status but was not associated with serum Tg, serum TgAb, serum TSH and thyroid status.
检测甲状腺球蛋白在淋巴结细针穿刺抽吸物中（FNA-Tg），对于诊断甲状腺乳头状癌（PTC）患者颈部淋巴结转移而言，是对超声和细针穿刺抽吸细胞学检查（FNAC）的有效补充。然而，在实际应用中，FNA-Tg并没有一个统一的临界值。我们旨在确定FNA-Tg的最佳临界值，并评估FNA-Tg的干扰因素。回顾性分析了317例PTC患者的405份颈部外侧淋巴结样本。采用受试者操作特征（ROC）曲线来确定FNA-Tg的最佳临界值。对影响FNA-Tg的因素进行了评估。恶性和良性淋巴结组之间的血清Tg、血清甲状腺球蛋白抗体（TgAb）、血清促甲状腺激素（TSH）水平以及甲状腺状态并无差异。无转移淋巴结的FNA-Tg中位数为3.81 ng/mL（0.16 - 33.40 ng/mL），有转移淋巴结的FNA-Tg中位数为310.32 ng/mL（124.41 - 500.00 ng/mL），差异具有统计学意义（P < 0.01）。FNA-Tg的最佳临界值为36.22 ng/mL，曲线下面积（AUC）、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为0.88、0.89、0.75、0.91和0.71。FNA-Tg临界值为36.22ng/mL时的诊断准确率为85%。当将FNAC与当前FNA-Tg临界值36.22 ng/mL联合使用时，诊断敏感性、特异性、PPV、NPV和诊断准确率分别为0.96、0.75、0.92、0.87和91%。FNA-Tg提高了FNAC对PTC颈部外侧淋巴结转移的诊断效能，FNA-Tg的最佳临界值为36.22 ng/mL。FNA-Tg受淋巴结状态影响，但与血清Tg、血清TgAb、血清TSH和甲状腺状态无关。
