We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine

Excellent diagnostic performance of FNA-Tg in detecting lymph nodes metastases from papillary thyroid cancer

    Jiahui Wang

    Department of Head & Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China

    ,
    Xianfeng Jiang

    *Author for correspondence:

    E-mail Address: Jiangxianfeng@zju.edu.cn

    Department of Head & Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China

    ,
    Guizhou Xiao

    Department of Head & Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China

    ,
    Weiping Zhou

    Department of Ultrasound, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China

    &
    Yan Hu

    Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China

    Published Online:https://doi.org/10.2217/fon-2020-0213

    Background: Thyroglobulin washout of fine needle aspiration (FNA-Tg) has proved to be useful in detecting lymph node metastases from papillary thyroid cancer; however, the influences of thyroid gland, Hashimoto thyroiditis, serum thyroglobulin (Tg) and anti-TG antibody on the diagnostic performance of FNA-Tg are controversial. Patients & methods: We retrospectively collected the FNA-Tg results of 176 preoperative or postoperative patients (356 lymph nodes) who finally were diagnosed with papillary thyroid cancer. The diagnostic abilities of FNA-Tg were evaluated and compared under different circumstances. Results: The diagnostic performance of FNA-Tg was uninfluenced irrespective of the status of thyroid gland or serum anti-TG antibody. However, high serum Tg was positively correlated with FNA-Tg (Exp(B) = 1.57; 95% CI: 1.209–2.309; p = 0.001). Conclusion: FNA-Tg was an excellent diagnostic tool, but it should be interpreted with caution only if serum Tg is higher than 10 ng/ml.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1. Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 317(13), 1338–1348 (2017).
    • 2. Kim SK, Chai YJ, Park I et al. Nomogram for predicting central node metastasis in papillary thyroid carcinoma. J. Surg. Oncol. 115(3), 266–272 (2017).
    • 3. Lee YM, Sung TY, Kim WB, Chung KW, Yoon JH, Hong SJ. Risk factors for recurrence in patients with papillary thyroid carcinoma undergoing modified radical neck dissection. Br. J. Surg. 103(8), 1020–1025 (2016).
    • 4. Podnos YD, Smith D, Wagman LD, Ellenhorn JD. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am. Surg. 71(9), 731–734 (2005).
    • 5. Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery 144(6), 1070–1078 (2008).
    • 6. Haugen BR, Alexander EK, Bible KC et al. American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1), 1–133 (2015). •• thyroglobulin washout of fine needle aspiration (FNA-Tg) is highly recommended by the treatment guideline of the American Thyroid Association.
    • 7. Leenhardt L, Erdogan MF, Hegedus L et al. 2013 European Thyroid Association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur. Thyroid J. 2(3), 147–159 (2013). •• FNA-Tg is highly recommended by the treatment guideline of the European Thyroid Association.
    • 8. Torres MR, Nobrega Neto SH, Rosas RJ, Martins AL, Ramos AL, da Cruz TR. Thyroglobulin in the washout fluid of lymph-node biopsy: what is its role in the follow-up of differentiated thyroid carcinoma? Thyroid 24(1), 7–18 (2004).
    • 9. Jiang HJ, Hsiao PJ. Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review. Kaohsiung J. Med. Sci. 36(4), 1–8 (2020). • A latest comprehensive review of the utility of FNA-Tg in clinical practice.
    • 10. Lee JH, Lee HC, Yi HW et al. Influence of thyroid gland status on the thyroglobulin cutoff level in washout fluid from cervical lymph nodes of patients with recurrent/metastatic papillary thyroid cancer. Head Neck 38(Suppl.1), E1705–1712 (2016).
    • 11. Zhao H, Wang Y, Wang MJ et al. Influence of presence/absence of thyroid gland on the cutoff value for thyroglobulin in lymph-node aspiration to detect metastatic papillary thyroid carcinoma. BMC Cancer 17(1), 296 (2017).
    • 12. Pak K, Suh S, Hong H et al. Diagnostic values of thyroglobulin measurement in fine-needle aspiration of lymph nodes inpatients with thyroid cancer. Endocrine 49(1), 70–77 (2015).
    • 13. Kim MJ, Kim EK, Kim BM et al. Thyroglobulin measurement in fine-needle aspirate washouts: the criteria for neck node dissection for patients with thyroid cancer. Clin. Endocrinol. 70(1), 145–151 (2009).
    • 14. Shin HJ, Lee HS, Kim EK, Moon HJ, Lee JH, Kwak JY. A study on serum antithyroglobulin antibodies interference in thyroglobulin measurement in fine-needle aspiration for diagnosing lymph node metastasis in postoperative patients. PLoS One 10(6), e0131096 (2015).
    • 15. Jeon MJ, Park JW, Han JM et al. Serum antithyroglobulin antibodies interfere with thyroglobulin detection in fine-needle aspirates of metastatic neck nodes in papillary thyroid carcinoma. J. Clin. Endocrinol. Metab. 98(1), 153–160 (2013).
    • 16. Borel AL, Boizel R, Faure P et al. Significance of low levels of thyroglobulin in fine-needle aspirates from cervical lymph nodes of patients with a history of differentiated thyroid cancer. Eur. J. Endocrinol. 158(5), 691–698 (2008). • Evaluation of the diagnostic performance of FNA-Tg and some confounding factors.
    • 17. Kim DW, Jeon SJ, Kim CG. Usefulness of thyroglobulin measurement in needle washouts of fine-needle aspiration biopsy for the diagnosis of cervical lymph node metastases from papillary thyroid cancer before thyroidectomy. Endocrine 42(2), 399–403 (2012).
    • 18. Bournaud C, Charrié A, Nozières C et al. Thyroglobulin measurement in fine needle aspirates of lymph nodes in patients with differentiated thyroid cancer: a simple definition of the threshold value, with emphasis on potential pitfalls of the method. Clin. Chem. Lab. Med. 48(8), 1171–1177 (2010).
    • 19. Boi F, Baghino G, Atzeni F, Lai ML, Faa G, Mariotti S. The diagnostic value for differentiated thyroid carcinoma metastases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies. J. Clin. Endocrinol. Metab. 91(4), 1364–1369 (2006). • Evaluation of the diagnostic performance of FNA-Tg and some confounding factors.
    • 20. Konca Degertekin C, Yalcin MM, Cerit T et al. Lymph node fine-needle aspiration washout thyroglobulin in papillary thyroid cancer: diagnostic value and the effect of thyroglobulin antibodies. Endocr. Res. 41(4), 281–289 (2016).
    • 21. Baskin HJ. Detection of recurrent papillary thyroid carcinoma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid 14(11), 959–963 (2004).
    • 22. Duval MADS, Zanella AB, Cristo AP, Faccin CS, Graudenz MS, Maia AL. Impact of serum TSH and anti-thyroglobulin antibody levels on lymph node fine-needle aspiration thyroglobulin measurements in differentiated thyroid cancer patients. Eur. Thyroid J. 6(6), 292–297 (2017).
    • 23. Gong Y, Yang J, Yan S et al. Pattern of and clinicopathologic risk factors for lateral lymph node metastases in papillary thyroid carcinoma patients with lateral cervical lymphadenopathy. Medicine (Baltimore) 97(36), e12263 (2018).
    • 24. Grani G, Fumarola A. Thyroglobulin in lymph node fine-needle aspiration washout: a systemic review and meta-analysis of diagnostic accuracy. J. Clin. Endocrinol. Metab. 99(6), 1970–1982 (2014).
    • 25. Pacini F, Fugazzola L, Lippi F et al. Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J. Clin. Endocrinol. Metab. 74(6), 1401–1404 (1992).
    • 26. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.. Biometrics. 44(3), 837–845 (1988).
    • 27. Hwang HS, Orloff LA. Efficacy of preoperative neck ultrasound in the detection of cervical lymph node metastasis from thyroid cancer. Laryngoscope 121(3), 487–491 (2011).
    • 28. Ahn JE, Lee JH, Yi JS et al. Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer. World J. Surg. 32(7), 1552–1558 (2008).
    • 29. Lim JH, Kim DW, Park JY et al. Ultrasonography, cytology, and thyroglobulin measurement results of cervical nodal metastasis in patients with unclear papillary thyroid carcinoma. Front. Endocrinol. (Lausanne) 10, 395 (2019).
    • 30. Al-Hilli Z, Strajina V, McKenzie TJ et al. Thyroglobulin measurement in fine-needle aspiration improves the diagnosis of cervical lymph node metastases in papillary thyroid carcinoma. Ann. Surg. Oncol. 24(3), 739–744 (2017).
    • 31. Frasoldati A, Pesenti M, Gallo M, Caroggio A, Salvo D, Valcavi R. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer 97(1), 90–96 (2003).
    • 32. Moon JH, Kim YI, Lim JA et al. Thyroglobulin in washout fluid from lymph node fine-needle aspiration biopsy in papillary thyroid cancer: large-scale validation of the cutoff value to determine malignancy and evaluation of discrepant results. J. Clin. Endocrinol. Metab. 98(3), 1061–1068 (2013). •• Evaluation of the diagnostic performance of FNA-Tg and validation of the cutoff value.
    • 33. Zhang X, Howell JM, Huang Y. Cervical lymph node fine-needle aspiration and needle-wash thyroglobulin reflex test for papillary thyroid carcinoma. Endocr. Pathol. 29(4), 346–350 (2018).
    • 34. Cunha N, Rodrigues F, Curado F et al. Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: a technique for the diagnosis of metastatic differentiated thyroid cancer. Eur. J. Endocrinol. 157(1), 101–107 (2007).
    • 35. Holmes BJ, Sokoll LJ, Li QK. Measurement of fine-needle aspiration thyroglobulin levels increases the detection of metastatic papillary thyroid carcinoma in cystic neck lesions. Cancer Cytopathol. 122(7), 521–526 (2014).
    • 36. Khadra H, Mohamed H, Al-Qurayshi Z, Sholl A, Killackey M, Kandil E. Superior detection of metastatic cystic lymphadenopathy in patients with papillary thyroid cancer by utilization of thyroglobulin washout. Head Neck 41(1), 225–229 (2019).
    • 37. Wunderbaldinger P, Harisinghani MG, Hahn PF et al. Cystic lymph node metastases in papillary thyroid carcinoma. Am. J. Roentgenol. 178(3), 693–697 (2002).
    • 38. Daniel PM, Pratt OE, Roitt IM, Torrigiani G. The release of thyroglobulin from the thyroid gland into thyroid lymphatics; the identification of thyroglobulin in the thyroid lymph and in the blood of monkeys by physical and immunological methods and its estimation by radioimmunoassay. Immunology 12(5), 489–504 (1967).
    • 39. McLeod DS, Cooper DS. The incidence and prevalence of thyroid autoimmunity. Endocrine 42(2), 252–265 (2012).
    • 40. Jara SM, Carson KA, Pai SI et al. The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in North American patients with papillary thyroid carcinoma. Surgery 154(6), 1272–1280 (2013).