Abstract
1292
Background: Thyroglobulin measurement in fine-needle aspiration (FNA-Tg) has been a standard procedure for diagnosing lymph node (LN) metastasis in papillary thyroid carcinoma (PTC). However, limited data have been reported regarding its performance in detecting lateral neck LN metastasis for preoperative evaluation in PTC.
Methods: FNA cytology and Tg level in the fine needle aspirates were assessed in 161 PTC patients (217 LNs) for preoperative evaluation. The extent of LN dissection in following surgery was mainly based on the FNA findings.
Results: Of the surgically removed 217 LNs, 113 (51.61%) were malignant. The median FNA-Tg concentration was 497.65 ng/mL in these metastatic LNs, whereas it was 2.54 ng/mL in 104 (48.39%) benign LNs (P<.0001). A FNA-Tg cutoff value of 46.05 ng/mL had the best diagnostic performance with 90.27% sensitivity and 76.92% specificity (AUC 0.884) in the whole group of 161 patients (n=217). We classified the LNs per the neck compartments from which they originate: central neck group (level VI, n=95) and lateral neck group (level II to V, n = 122). In the central neck group, the sensitivity and specificity of the FNA-Tg cutoff value of 123.3 ng/mL were 82.35% and 63.64%, respectively (PPV, 72.41%, NPV, 80.82%). An improved diagnostic performance was revealed in the lateral neck group, as sensitivity and specificity of the FNA-Tg cutoff of 16.8 ng/mL were 93.55% and 95.00%, respectively (AUC 0.976, PPV 95.08% and NPV 93.44%).
Conclusions: Tg measurement in fine needle aspirate is a useful technique for diagnosis of LN metastasis before surgery. Its use should be considered to avoid missing metastatic disease in lymphadenectomy, especially in lateral neck dissection.
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