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Intraoperative measurement of thyroglobulin in lymph node aspirates for the detection of metastatic papillary thyroid carcinoma

Authors Wang Y, Liu Y, Wang X, Li X, Jiang R, He X

Received 28 April 2017

Accepted for publication 3 August 2017

Published 11 September 2017 Volume 2017:10 Pages 4435—4441

DOI https://doi.org/10.2147/OTT.S140643

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 4

Editor who approved publication: Dr Samir Farghaly

Yizeng Wang, Yuanchao Liu, Xiaoning Wang, Xin Li, Ruoyu Jiang, Xianghui He

Department of General Surgery, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, People’s Republic of China

Background: Among patients with papillary thyroid carcinoma (PTC), 30%–80% have cervical lymph node (LN) metastases, which are most commonly located in the central compartment. However, preoperative ultrasonography identifies malignant central compartment LNs in only 20%–30% of cases. We aimed to evaluate the diagnostic value of intraoperative thyroglobulin (Tg) measurement in fine-needle aspirates (FNA-Tg) of suspicious metastatic LNs.
Methods: In total, 75 patients (75 LNs) with PTC or suspected PTC were enrolled in this study. Suspicious metastatic LNs were isolated intraoperatively, and FNA-Tg was performed. Then, the Tg values were compared with the corresponding pathological results and preoperative ultrasonography.
Results: In total, 37 LNs were diagnosed as malignant, and 38 were benign. According to the receiver operating characteristic (ROC) curve, the optimal cutoff value of intraoperative FNA-Tg was 147.5 ng/mL (sensitivity, 81.1%; specificity, 100%; p=0.000). The sensitivity and specificity for detecting central compartment LN metastasis were 77.78% (21/27) and 100% (36/36), respectively. The corresponding sensitivity of preoperative ultrasonography was lower than that of FNA-Tg (p=0.000). Serum Tg-antibody (Ab), thyroid-stimulating hormone (TSH) and thyroid peroxidase antibody (TPO-Ab) were not significantly associated with FNA-Tg values. There was no statistical correlation between preoperative serum Tg and intraoperative FNA-Tg (p=0.451).
Conclusion: Intraoperative FNA-Tg levels of suspicious metastatic cervical LNs can be useful for diagnosing metastatic PTC. Intraoperative LN-FNA-Tg may have an important role in determining which surgical procedure to perform.

Keywords: papillary thyroid carcinoma, lymph node metastasis, intraoperative thyroglobulin measurement, fine-needle aspirates, preoperative ultrasonography

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