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
- Authors
- Moon, Jae Hoon; Kim, Yong Il; Lim, Jung Ah; Choi, Hoon Sung; Cho, Sun Wook; Kim, Kyung Won; Park, Hyo Jin; Paeng, Jin Chul; Park, Young Joo; Yi, Ka Hee; Park, Do Joon; Kim, Sang Eun; Chung, June-Key
- Issue Date
- Mar-2013
- Publisher
- ENDOCRINE SOC
- Citation
- JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, v.98, no.3, pp 1061 - 1068
- Pages
- 8
- Journal Title
- JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
- Volume
- 98
- Number
- 3
- Start Page
- 1061
- End Page
- 1068
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/74480
- DOI
- 10.1210/jc.2012-3291
- ISSN
- 0021-972X
1945-7197
- Abstract
- Context: There are still some controversies regarding the cutoff value and the influential factors of thyroglobulin (Tg) concentration in washout fluid from fine-needle aspiration (FNA) biopsy (FNA-Tg) on cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC). Objective: Our aims were to validate the cutoff value of FNA-Tg in diagnosing malignant LNs on a large scale and to investigate the influential factors that could result in the discrepancy between the final diagnosis and FNA-Tg. Design, Setting, and Participants: We conducted a retrospective cohort study based on hospital records with 528 cases of FNA-Tg measurement from 419 PTC patients. Main Outcome Measure: The cutoff value of FNA-Tg was obtained from receiver operating characteristic analysis with final diagnosis. Binary logistic regression analysis was performed to investigate the influential factors. Results: In the final diagnosis, 190 LNs were malignant, and 338 LNs were benign. The median FNA-Tg was 521.2 (3676.8) ng/mL in malignant LNs, and 0.1 (0.2) ng/mL in benign LNs. The optimal cutoff value of FNA-Tg in distinguishing malignant LNs from benign LNs was 1.0 ng/mL (sensitivity, 93.2%; specificity, 95.9%) in all cases. Combining FNA-Tg and FNA cytology showed superior diagnostic power (sensitivity, 98.4%; specificity, 94.4%) when compared with diagnostic strategy using either FNA cytology or FNA-Tg alone. FNA-Tg, serum TSH, and serum Tg were higher in nonthyroidectomized patients than in thyroidectomized patients (P <.001, respectively). FNA-Tg was correlated with serum TSH and Tg levels (P <.001, respectively), and binary logistic regression analysis showed that serum TSH suppression and serum Tg presence independently affected the diagnosis made by FNA-Tg. Conclusions: Our results validated 1.0 ng/mL of FNA-Tg as a cutoff value for diagnosing LN metastasis of PTC and suggested that serum TSH suppression and serum Tg presence should be considered in diagnosing LN malignancy with FNA-Tg in PTC patients. (J Clin Endocrinol Metab 98: 1061-1068, 2013)
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