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  • Title: [Fine-needle aspiration for the diagnosis of lymph node metastasis in papillary thyroid carcinoma].
    Author: Wang TX, Song YT, Xu GH, Yu WB, Wei W, Zhang B.
    Journal: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2019 Jan 07; 54(1):23-27. PubMed ID: 30704165.
    Abstract:
    Objective: To investigate the diagnostic performance of fine-needle aspiration (FNA) cytology for the detection of lateral lymph node metastases in patients with papillary thyroid carcinoma (PTC). Methods: A total of 109 lateral lymph nodes with suspicious metastases from 85 patients were retrospectively subjected to FNAC, fine-needle aspiration thyroglobulin measurement (FNATg), and FNATg/SerumTg measurement. Lymph node pathological results after surgery were taken as the gold standard. Using Mann-Whitney U test, Pearson linear model and ROC curve were used for data analysis. Results: The sensitivity, specificity and accuracy of FNATg for the diagnosis of lateral neck lymph node metastasis were respectively 93.7%, 90.0% and 93.3% and those of FNATg/SerumTg were respectively 89.9%, 90.0% and 93.2% respectively, the threshold values for FNATg and FNATg/SerumTg were 0.925 ng/ml and 1.007, respectively. The sensitivity, specificity and accuracy of FNATg combined with FNAC were respectively 91.0%,93.5% and 94.4%. The existence of thyroid tissue and the expression of serum Tg did not affect the expression of lymph node FNATg. The FNATg cutoff value of 0.925 ng/ml showed the best diagnostic performance in patients with a thyroid gland, while the FNATg/SerumTg cutoff ratio of 14.95 showed the best diagnostic performance in patients without a thyroid gland. The serum TgAb significantly interfered with the expression of FNATg in the lateral neck metastatic lymph nodes (P=0.049). Conclusions: FNATg alone or the combination of FNATg with FNAC are highly reliable in the diagnosis of lateral neck lymph node metastases in patients with PTC. The expression of TgAb may interfere with the accuracy of the diagnostic performance of FNATg. 目的： 评价超声引导下细针穿刺技术（fine-needle aspiration，FNA）在诊断甲状腺乳头状癌侧颈淋巴转移的预测价值。 方法： 回顾性分析85例甲状腺乳头状癌患者的109枚超声怀疑转移的侧颈淋巴结，行细针穿刺细胞学检查（fine needle aspiration cytology，FNAC），细针穿刺甲状腺球蛋白检测（fine needle aspiration thyroglobulin，FNATg），细针穿刺甲状腺球蛋白/外周血甲状腺球蛋白检测（FNATg/SerumTg），以手术病理诊断作为淋巴转移的金标准，判断侧颈淋巴结细针穿刺的诊断价值。用非参数检验，Pearson线性模型及受试者工作特征曲线对研究结果进行分析。 结果： FNATg和FNATg/SerumTg在诊断甲状腺癌侧颈淋巴转移的灵敏度、特异度和准确率分别为93.7%、90.0%，93.3%和89.9%、90.0%和93.2%，其预测淋巴转移的临界值分别为0.925 ng/ml和1.007，FNATg联合FNAC诊断的灵敏度、特异度和准确率分别为91.0%、93.5%和94.4%；甲状腺组织和外周血Tg对侧颈淋巴结FNATg的检测结果无明显影响，在患者有甲状腺组织的情况下采用淋巴结FNATg的诊断准确性最高（临界值0.925 ng/ml），在患者无甲状腺组织的情况下采用FNATg/SerumTg的诊断准确性最高（临界值14.95）；外周血中甲状腺球蛋白抗体（TgAb）的存在显著影响了有甲状腺癌转移淋巴结FNATg的表达水平（P=0.049）。 结论： 侧颈淋巴结FNATg检测或联合FNAC检测可有效监测甲状腺乳头状癌的侧颈淋巴转移，外周血TgAb的存在影响了FNATg用于预测甲状腺乳头状癌侧颈淋巴转移的准确性。.
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