Thyroglobulin in lymph node fine-needle aspiration biopsy washout fluid. A tertiary center experience

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Published Dec 18, 2021
DOI: https://doi.org/10.22551/2021.33.0804.10194
Laura Deacu Dan Alexandru Niculescu Andra Caragheorgheopol Dana Terzea Cătălina Poiană

Abstract

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Most PTC secretes thyroglobulin, a useful marker in monitoring preoperative staging and postoperative progression; in addition to serum thyroglobulin, fine needle aspiration washout thyroglobulin (FNA-Tg) is also used. Our aim was to determine the cut-off value for FNA-Tg in our center and to describe major discrepancies between FNA-Tg, cytology and pathology results of the lymph nodes. Methods: We retrospectively retrieved from the electronic database of our endocrinology center all the FNA-Tg measurements between December 10, 2019 and September 2021. For each measurement we also retrieved the corresponding sex, FNAB results and the pathology reports. FNA-Tg was measured by ECLIA immunoelectro-chemiluminescent method. Results: There were 58 FNAB and FNA-Tg of suspect cervical lymph nodes in 40 patients. There were 17 cytologically benign lymph nodes of which 13 had low and 4 had high FNA-Tg; 3 non-diagnostic cytology results of which one had high FNA-Tg; 38 PTC metastases of which 6 had low and 32 had high FNA-Tg titers. The cut-off value of FNA-Tg in our center is 10 ng/ml, with a sensitivity of 86.6% (in those with pathology reports available after surgery). Conclusions: Washout TG is useful in suspicious lymph nodes and has added value to cytology in selected cases. The cut-off value of FNA-Tg in our center is 10 ng/ml, with a sensitivity of 86.6%. However, we must consider the possible false negative results that may occur in some histological types of PTC.

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Keywords

washout thyroglobulin, papillary thyroid carcinoma, lymph nodes, fine-needle aspiration biopsy

References
1. Kim WB. A closer look at papillary thyroid carcinoma. Endocrinol Metab (Seoul). 2015; 30(1):1-6. doi:10.3803/EnM.2015.30.1.1.
2. Wang LY, Ganly I. Nodal metastases in thyroid cancer: prognostic implications and management. Future Oncol. 2016; 12(7):981-994. doi:10.2217/fon.16.10
3. Wang LY, Palmer FL, Nixon IJ, et al. Lateral neck lymph node characteristics prognostic of outcome in patients with clinically evident n1b papillary thyroid cancer. Ann Surg Oncol. 2015; 22(11):3530-3536. doi:10.1245/s10434-015-4398-2.
4. Wang LY, Palmer FL, Nixon IJ, et al. Central lymph node characteristics predictive of outcome in patients with differentiated thyroid cancer. Thyroid. 2014; 24(12):1790-5. doi 10.1089/thy.2014.0256.
5. 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. 2016; 41(4):281-289. doi: 10.3109/07435800.2016.1141936.
6. Poalelungi C, Parvu L, Padure A, et al. Analytical validation of a thyroglobulin immunoassay in fine-needle aspirate washout of suspicious lymph nodes in patients with differentiated thyroid cancer. Clinica Chimica Acta. 2019; 493 (Supp 1):S317. doi:10.1016/j.cca.2019.03.690.
7. 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. The J Clin Endocrinol Metab. 2013; 98(3):1061–1068. doi: 10.1210/jc.2012-3291.
8. Jung JY, Shin JH, Han BK, Ko EY. Optimized cutoff value and indication for washout thyroglobulin level according to ultrasound findings in patients with well-differentiated thyroid cancer. AJNR Am J Neuroradiol. 2013; 34(12) 2349-235. doi: 10.3174/ajnr.A3687.
9. Casado CF, Bravo TA, Guerrero IM, Carrasco AR, García C, Villanueva Curto S. The value of thyroglobulin in washout of fine needle aspirate from 16 cervical lesions in patients with thyroid cancer. Endocrinol Nutr. 2013; 60(9):495-503. doi: 10.1016/j.endonu.2013.02.003.
10. 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. 1992; 74(6): 1401-1404. doi: 10.1210/jcem.74.6.1592886.
11. Mikosinski S, Pomorski L, Oszukowska L, et al. The diagnostic value of thyroglobulin concentration in fine-needle aspiration of the cervical lymph nodes in patients with differentiated thyroid cancer. Endokrynol Pol. 2006; 57(4):392-395.
12. Snozek CL, Chambers EP, Reading CC, et al. Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin Endocrinol Metab. 2007; 92(11):4278-4281. doi: 10.1210/jc.2007-1075.
How to Cite
Deacu, L., Niculescu, D. A., Caragheorgheopol, A., Terzea, D., & Poiană, C. (2021). Thyroglobulin in lymph node fine-needle aspiration biopsy washout fluid. A tertiary center experience. Archive of Clinical Cases, 8(4), Arch Clin Cases 2021; 8(4):106-110. https://doi.org/10.22551/2021.33.0804.10194
Issue
Vol. 8 No. 4 (2021): Thyroid Cancer
Section
Original studies

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How to Cite

Deacu, L., Niculescu, D. A., Caragheorgheopol, A., Terzea, D., & Poiană, C. (2021). Thyroglobulin in lymph node fine-needle aspiration biopsy washout fluid. A tertiary center experience. Archive of Clinical Cases, 8(4), Arch Clin Cases 2021; 8(4):106-110. https://doi.org/10.22551/2021.33.0804.10194