Thyroglobulin Measurement in Fine-Needle Aspiration Improves the Diagnosis of Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma

Al‐Hilli, Zahraa; Strajina, Veljko; McKenzie, Travis J.; Thompson, Geoffrey B.; Farley, David R.; Castro, M. Regina; Algeciras‐Schimnich, Alicia; Richards, Melanie L.

doi:10.1245/s10434-016-5625-1

Cited by 29 publications

(36 citation statements)

References 23 publications

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“…Cervical lymph node metastasis in patients with PTC is closely related to the prognosis. Accurate diagnosis of metastatic cervical lymph nodes before surgery is essential[9-11]. Currently, ultrasound is commonly used in the diagnosis of PTC cervical lymph node metastasis[12-14].…”

Section: Discussionmentioning

confidence: 99%

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

Jiang¹,

H²,

Zhang³

et al. 2019

WJCC

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BACKGROUNDCervical lymph node metastasis in papillary thyroid carcinoma (PTC) affects the treatment and prognosis of patients. Ultrasound is a common imaging method for detecting cervical lymph nodes in PTC patients; however, it is not accurate in determining lymph node metastasis.AIMTo evaluate the value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in PTC.METHODSA total of 94 patients with PTC were recruited. According to pathological results, lymph nodes were divided into two groups: metastatic group (n = 50) and reactive group (n = 63). The routine ultrasound findings, contrast-enhanced ultrasound and elastography data were recorded and compared. Logistic regression was used to generate predictive probability distributions for the diagnosis of lymph node metastasis with different indicators. Receiver operating characteristic curve analysis was used to test the efficacy of contrast-enhanced ultrasound combined with elastography based on routine ultrasound in evaluating PTC cervical lymph node metastasis.RESULTSThe ratio of long diameter/short diameter (L/S) ≤ 2, irregular marginal morphology, missing lymphatic portal, peripheral or mixed blood flow distribution, peak intensity (PI), non-uniform contrast distribution and elasticity score in the metastatic group were significantly higher than those in the reactive group (P < 0.05). L/S ratio, missing lymphatic portal, PI and elasticity score had a significant influence on the occurrence of PTC cervical lymph node metastasis (P < 0.05). Furthermore, the area under the curve (AUC) for lymph node metastasis diagnosed using the combination of PI ratio, elasticity score, missing lymphatic portal and LS was 0.936, which was significantly higher than the AUC for PI ratio alone. The difference was statistically significant (P < 0.05). The fitting equation for the combined diagnosis was logit(P) = -12.341 + 1.482 × L/S ratio + 3.529 × missing lymphatic portal + 0.392 × PI + 3.288 × elasticity score.CONCLUSIONBased on the gray-scale ultrasound, the combination of contrast-enhanced ultrasound and elastography can accurately assess PTC cervical lymph node metastasis.

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Section: Discussionmentioning

confidence: 99%

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

Jiang¹,

H²,

Zhang³

et al. 2019

WJCC

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“…The value of FNA in the diagnosis of lymph node metastases has been widely established in previous studies . In our study, it was possible to perform a preliminary qualitative diagnosis in most cases of metastatic NPC on the basis of distinctly shaped cells, where a high sensitivity was achieved by observing FNA cell smears (86.8%).…”

Section: Discussionmentioning

confidence: 82%

“…Accordingly, EBERs play a helpful role in the diagnosis of NPC. Some of the histomorphological features of NPC15 can partially be observed in lymph node metastases, which serves as evidence in smears.The value of FNA in the diagnosis of lymph node metastases has been widely established in previous studies [18][19][20][21][22][23]. In our study, it was possible to perform a preliminary qualitative diagnosis in most cases of metastatic NPC on the basis of distinctly shaped cells, where a high sensitivity was achieved by observing FNA cell smears (86.8%).…”

mentioning

confidence: 63%

Diagnostic utility of immunohistochemical analysis and Epstein–Barr virus‐encoded small RNAs in situ hybridisation of cell block sections obtained using fine‐needle aspiration in nasopharyngeal carcinoma with lymph node metastasis

Zhang

Xing

Yang

et al. 2018

Diagnostic Cytopathology

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Objective This study aimed to investigate the diagnostic utility of immunohistochemistry (IHC) analysis (FNA) and Epstein–Barr virus‐ (EBV) encoded small RNAs (EBERs) in situ hybridisation analyses of cell block (CB) sections obtained using fine needle aspiration in nasopharyngeal carcinoma (NPC) with lymph node metastasis. Methods A total of 38 FNA biopsies were collected using a Youyi aspirator. The cytomorphology, CB‐based histomorphology, IHC, and EBERs in situ hybridisation were observed and the sensitivity/final diagnostic rates were compared with those of simple smears and a combination of smears and CBs. Results The 38 cases of metastatic lymph nodes from NPC displayed the morphological characteristics of non‐keratinising carcinoma in cell smears and CB sections. The tumour cells showed high expression of CK5/6, P63, Ki‐67, and EBERs (94.7%, 36/38 cases) in the CB sections. The sensitivity and the final diagnostic rates were lowest with the simple cell smears (86.8%, 33/38 and 71.1%, 27/38 cases), moderate with the smears combined with CB sections (92.1%, 35/38 cases and 81.6%, 31/38 cases), and the highest with IHC and EBERs in situ hybridisation (94.7%, 36/38 and 94.7%, 36/38 cases). Conclusions FNA has great value in the diagnosis of NPC with lymph node metastases, and using cell smears combined with IHC and EBERs in situ hybridisation of CB sections could help clinical doctors promptly identify the primary lesions.

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“…However, US has several limitations, such as low sensitivity and operator dependency (2). Cytology after US-guided FNA of the cervical LNs has high specificity, but a 5–10% inadequacy rate and a 6–50% false-negative rate, especially in LNs with small size or cystic change (3, 14–16). In our study, 10 patients (29.4%, 10/34) had false-negative cytology, and among them, 9 (90%) showed cystic change of the LNs on US.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography, Cytology, and Thyroglobulin Measurement Results of Cervical Nodal Metastasis in Patients With Unclear Papillary Thyroid Carcinoma

et al. 2019

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Objective: This study aimed to evaluate the ultrasonography (US), cytology, and thyroglobulin (Tg) measurement results of nodal metastasis in patients showing unclear US or cytology results of primary papillary thyroid carcinoma (PTC). Methods: From January 2016 to December 2018, 179 patients underwent US-guided fine-needle aspiration (FNA) to diagnose lymphadenopathy in the neck. Among them, 36 patients underwent subsequent total thyroidectomy and nodal dissection, and cervical lymph node (LN) metastasis from PTC was confirmed. However, two patients were excluded because of mismatch between the US and pathological findings of LNs. US images and cytological slides for metastatic LNs were retrospectively analyzed, and serum and FNA Tg levels for metastatic LNs were investigated using data from the electric medical records. Primary PTC patients with suspicious results on both US and cytology were classified as the clear group, and the remaining patients were classified as the unclear group. Results: Of the 34 patients, 24 had clear results of primary PTC on both US and cytology (clear group), whereas 10 had unclear results of primary PTC on US or cytology (unclear group). Of the 10 patients in the unclear group, seven had suspicious nodal metastasis from PTC on cytology after US-guided FNA of the cervical LN, and the remaining three had negative cytology but a positive Tg measurement. Metastatic LNs with cystic change tended to show a positive Tg measurement but negative cytology. Conclusions: The combination of US, cytology, and Tg measurement is necessary for diagnosing nodal metastasis from PTC. In cases with unclear primary PTC on US or cytology, the detection of nodal metastasis may be helpful for assessing primary PTC.

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Thyroglobulin Measurement in Fine-Needle Aspiration Improves the Diagnosis of Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma

Abstract: For diagnosing cervical lymph node metastases in PTC, FNA-Tg is a valuable adjunct to FNAC. Its use should be considered to avoid missing metastatic disease in patients who may benefit from lymphadenectomy.

Cited by 29 publications

References 23 publications

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

Value of contrast-enhanced ultrasound combined with elastography in evaluating cervical lymph node metastasis in papillary thyroid carcinoma

Diagnostic utility of immunohistochemical analysis and Epstein–Barr virus‐encoded small RNAs in situ hybridisation of cell block sections obtained using fine‐needle aspiration in nasopharyngeal carcinoma with lymph node metastasis

Ultrasonography, Cytology, and Thyroglobulin Measurement Results of Cervical Nodal Metastasis in Patients With Unclear Papillary Thyroid Carcinoma

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