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Park J, An S, Kim K, Kim JS, Jung CK, Bae JS. Diagnostic utilities of washout CYFRA 21-1 combined with washout thyroglobulin for metastatic lymph nodes in thyroid cancer: a prospective study. Sci Rep 2024; 14:7599. [PMID: 38556517 PMCID: PMC10982287 DOI: 10.1038/s41598-024-58093-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Abstract
Cervical lymph node (LN) metastasis is common in differentiated thyroid cancer (DTC). This study evaluated the utility of the washout CYFRA 21-1 level, combined with the thyroglobulin (Tg) concentration, in terms of diagnosis of LN metastasis. We prospectively enrolled 53 patients who underwent thyroid surgery to treat DTC with lateral cervical LN metastases. Preoperative ultrasound guided needle localization was used to surgical sampling of specific LNs during the operation. The intraoperative washout Tg and CYFRA 21-1 levels were measured in such LNs. The Tg and CYFRA 21-1 levels differed significantly between metastatic and benign LNs. The cutoff values were 2.63 ng/mL for washout CYFRA 21-1 and 22.62 ng/mL for Tg. Combined use of the washout Tg and CYFRA 21-1 levels afforded the highest diagnostic accuracy (92.5%), better than that of individual markers. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 94.6%, 90.0%, 91.4%, 93.8%, respectively. The conjunction of the washout CYFRA21-1 and Tg levels enhances the diagnostic accuracy of LN metastasis in DTC patients. The washout CYFRA 21-1 level may be useful when malignancy is suspected, especially in cases where the cytology and washout Tg findings do not provide definitive results.
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Affiliation(s)
- Joonseon Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Solji An
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Liu SQ, Feng JW, Yan ZT, Xing XX, Jiang WY, Jiang Y, Qian F, Xing W. Constructing a nomogram based on the distribution of thyroid nodules and suspicious lateral cervical lymph nodes in fine-needle aspiration biopsies to predict metastasis in papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2023; 14:1242061. [PMID: 38089614 PMCID: PMC10715253 DOI: 10.3389/fendo.2023.1242061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/17/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose Elevated concentrations of thyroglobulin eluent is a risk factor for lateral cervical lymph node metastasis (LLNM) in patients with papillary thyroid cancer (PTC). We aimed to develop a practical nomogram based on the distribution of thyroid nodules and the presence of suspicious lateral cervical lymph nodes in fine-needle aspiration biopsies (LN-FNABs), including the cytopathology and the suspicious lateral cervical lymph node (LLN) thyroglobulin eluent (Tg), to predict the possibility of LLNM preoperatively in patients with PTC. Methods The clinical data of PTC patients who were admitted to the Third Affiliated Hospital of Soochow University from January 2022 to May 2023 to undergo fine-needle aspiration biopsy (FNAB) were included in this study. A total of 208 patients in 2022 served as the training set (70%), and 89 patients in 2023 served as the validation set (30%). The clinical characteristics and LN-FNAB results were collected to determine the risk factors of LLNM. A preoperative nomogram was developed for predicting LLNM based on the results of the univariate and multivariate analyses. Internal calibration, external calibration, and decision curve analysis (DCA) were performed for these models. Results The multivariate logistic regression analysis showed that the maximum thyroid nodule diameter (Odds Ratio (OR) 2.323, 95% CI 1.383 to 3.904; p = 0.001), Tg level (OR 1.007, 95% CI 1.005 to 1.009; p = 0.000), Tg divided by serum thyroglobulin, (Tg/sTg) [odds ratio (OR) 1.005, 95% CI 1.001 to 1.008; p = 0.009], and cytopathology (OR 9.738, 95% CI 3.678 to 25.783; p = 0.000) (all p < 0.05) had a significant impact on the LLNM of patients with suspicious LLNs. The nomogram showed a better predictive value in both the training cohort [area under the curve, (AUC) 0.937, 95% CI 0.895 to 0.966] and the validation cohort (AUC 0.957, 95% CI 0.892 to 0.989). The nomogram also showed excellent internal and external calibration in predicting LLNM. According to the DCA, the diagnostic performance of this model was dependent on the following variables: maximum thyroid nodule diameter, Tg level, Tg/sTg, and cytopathology. Conclusion Based on the aforementioned risk factors, we believe that it is necessary to establish a personalized LLNM model for patients with PTC. Using this practical nomogram, which combines clinical and Tg risk factors, surgeons could accurately predict the possibility of LLNM preoperatively. The nomogram will also help surgeons to establish personalized treatment plans before surgery.
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Affiliation(s)
- Shui-Qing Liu
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, Jiangsu, China
| | - Jia-Wei Feng
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, China
| | - Zhan-Tao Yan
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, Jiangsu, China
| | - Xiao-Xiao Xing
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, Jiangsu, China
| | - Wen-Yin Jiang
- Department of Breast Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, Jiangsu, China
| | - Yong Jiang
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, China
| | - Feng Qian
- Department of Ultrasound, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, Jiangsu, China
| | - Wei Xing
- Department of Medical Imaging, The Third Affiliated Hospital of Suzhou University, Changzhou First People’s Hospital, Changzhou, Jiangsu, China
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Liu Q, Mao L, Zhang Z, Li G, Song H. Diagnostic Efficacy of FNA-Tg in DTC Cervical LN Metastasis and its Impact Factors: A Large Retrospective Study. J Clin Endocrinol Metab 2023; 108:3311-3319. [PMID: 37279938 DOI: 10.1210/clinem/dgad335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023]
Abstract
CONTEXT Thyroglobulin in needle washout fluid (FNA-Tg) has the advantage of compensating for the low sensitivity of cytological analysis (FNAC) in differentiated thyroid carcinoma (DTC) lymph node (LN) metastasis. However, studies of large data sets to support this view and identify the best cutoff of FNA-Tg are lacking. OBJECTIVE Our study aimed to determine the best cutoff of FNA-Tg and explore the impact factors of FNA-Tg. METHOD A total of 1106 suspicious LNs from patients treated at West China Hospital from October 2019 to August 2021 were included. Parameters were compared between metastatic and benign LNs, and the best cutoff value of FNA-Tg was identified by ROC curves. The impact factors of FNA-Tg were analyzed. RESULTS In the nonsurgery group, after correcting for the effect of age and short diameter of LN, FNA-Tg was the independent risk factor for cervical LN metastasis of DTC (odds ratio [OR]: 1.048; 95% CI, 1.032-1.065). In the surgery group, after correcting for the effects of serum thyrotropin, serum Tg, long diameter of LN, and short diameter of LN, FNA-Tg was the independent risk factor for cervical LN metastasis of DTC (OR: 1.019; 95% CI, 1.006-1.033). The best cutoff value of FNA-Tg was 25.17 μg/L, and the area under the receiver operating characteristic curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.944, 0.847, 0.978, 0.982, 0.819, and 0.902, respectively. FNA-Tg highly correlated with FNA-TgAb (P < .01; Spearman correlation coefficient = 0.559), but FNA-TgAb positivity did not undermine the diagnostic efficacy of FNA-Tg for DTC LN metastasis. CONCLUSION The best cutoff value of FNA-Tg was 25.17 μg/L in diagnosing DTC cervical LN metastasis. FNA-Tg highly correlated with FNA-TgAb, but FNA-TgAb had no influence on the diagnostic efficacy of FNA-Tg.
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Affiliation(s)
- Qianhui Liu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Li Mao
- Medical Laboratory, People's Hospital of Dayi County, Chengdu, 611330, Sichuan, China
| | - Ziwei Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Guixing Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Haolan Song
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
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Ho J, Kim D, Lee JE, Kim JK, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY. Single-Port Transaxillary Robotic Modified Radical Neck Dissection (STAR-RND): Initial Experiences. Laryngoscope 2023; 133:709-714. [PMID: 36308330 DOI: 10.1002/lary.30437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/12/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study aimed to demonstrate the usefulness of single-port transaxillary robotic modified radical neck dissection (STAR-RND) for metastatic thyroid cancer, and its potential to make small and invisible surgical wounds possible compared to open modified radical neck dissection. METHODS Between January 2020 and July 2021, 30 thyroid cancer patients who underwent lateral neck dissection surgery with the da Vinci SP at Yonsei University Health System (Seoul, Korea) were studied. RESULTS All 30 patients, diagnosed with papillary thyroid cancer were women. The average operating time was 293.80 ± 36.58 (min), and the average postoperative hospital stay was 4.77 ± 0.57 (days). All patients were discharged after the expected number of hospitalization days without major complications. CONCLUSION STAR-RND is technically feasible and safe with a short length of the incision. To our knowledge, this is the first report on the use of a single-port robotic system for modified radical neck dissection. LEVEL OF EVIDENCE BY USING 2011 OCEBM: 4 Laryngoscope, 133:709-714, 2023.
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Affiliation(s)
- Joon Ho
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Donggyu Kim
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji-Eun Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Kyong Kim
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Cho Rok Lee
- Department of Surgery, Yongin Severance Hospital, Gyeonggi-do, South Korea
| | - Sang-Wook Kang
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Ju Jeong
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kee-Hyun Nam
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woong Youn Chung
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Song Y, Wang J, Zhu Y, Xu G, Wang T, Zhang B. Is thyroglobulin detection in fine-needle aspirates useful for the diagnosis of central neck metastatic papillary thyroid cancer? Endocr Connect 2022; 11:e220353. [PMID: 36173821 PMCID: PMC9641774 DOI: 10.1530/ec-22-0353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/29/2022] [Indexed: 11/08/2022]
Abstract
Objective The central neck lymph node (LN) status is important for the treatment strategy of papillary thyroid cancer (PTC), while the diagnosis is difficult. This study aims to evaluate the diagnostic value of fine-needle aspiration (FNA) and its washout thyroglobulin (FNA-Tg) detection in central neck LN metastasis. Methods Central neck LNs with FNA cytology (FNA-C) and FNA-Tg measurements from a tertiary hospital were included. Tg levels were correlated with histopathological or follow-up results. The diagnostic performance of FNA-C, FNA-Tg, and combining FNA-C and FNA-Tg for detecting LN metastasis was assessed. Results A total of 132 LNs in the central neck from 129 patients were studied. The median FNA-Tg concentration of 74 metastatic LNs was 552.5 ng/mL, whereas, in 58 benign LNs, the median Tg concentration was 0.1 ng/mL (P < 0.001). Receiver operating characteristic analysis (area under the curve, 0.861) was used, and a cutoff value of 14.6 ng/mL was obtained. There was no significant increase in the diagnostic accuracy when FNA-Tg was used or combined with FNA-C, compared with FNA-C alone. The size, location of LNs, the presence of the ipsilateral thyroid gland, and Hashimoto's thyroiditis did not affect the incidence of misdiagnosis. Conclusions FNA-C is the gold standard for evaluating central neck metastasis in PTC patients. Measurement of Tg levels in FNA washout does not improve the diagnostic accuracy any further.
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Affiliation(s)
- Yuntao Song
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jiaxin Wang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Yanli Zhu
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Guohui Xu
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tianxiao Wang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bin Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing, Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, Beijing, China
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Wang SR, Li QL, Tian F, Li J, Li WX, Chen M, Sang T, Cao CL, Shi LN. Diagnostic value of multiple diagnostic methods for lymph node metastases of papillary thyroid carcinoma: A systematic review and meta-analysis. Front Oncol 2022; 12:990603. [PMID: 36439514 PMCID: PMC9686443 DOI: 10.3389/fonc.2022.990603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE This study compared the diagnostic value of various diagnostic methods for lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) through network meta-analysis. METHODS In this experiment, databases such as CNKI, Wanfang, PubMed, and Web of Science were retrieved according to the Cochrane database, Prisma, and NMAP command manual. A meta-analysis was performed using STATA 15.0, and the value of the surface under the cumulative ranking curve (SUCRA) was used to determine the most effective diagnostic method. Quality assessments were performed using the Cochrane Collaboration's risk of bias tool, and publication bias was assessed using Deeks' funnel plot. RESULTS A total of 38 articles with a total of 6285 patients were included. A total of 12 diagnostic methods were used to study patients with LNM of PTC. The results showed that 12 studies were direct comparisons and 8 studies were indirect comparisons. According to the comprehensive analysis of the area of SUCRA, US+CT(86.8) had the highest sensitivity, FNAC had the highest specificity (92.4) and true positive predictive value (89.4), and FNAC+FNA-Tg had higher negative predictive value (99.4) and accuracy (86.8). In the non-invasive method, US+CT had the highest sensitivity, and the sensitivity (SEN) was [OR=0.59, 95% confidence interval (CI): (0.30, 0.89]. Among the invasive methods, the combined application of FNAC+FNA-Tg had higher diagnostic performance. The sensitivity was [OR=0.62, 95% CI: (0.26, 0.98)], the specificity (SPE) was [OR=1.12, 95% CI: (0.59, 1.64)], the positive predictive value was [OR=0.98, 95% CI: (0.59, 1.37)], the negative predictive value was [OR=0.64, 95% CI (0.38, 0.90)], and the accuracy was [OR=0.71, 95% CI: (0.31, 1.12)]. CONCLUSION In the non-invasive method, the combined application of US+CT had good diagnostic performance, and in the invasive method, the combined application of FNAC+FNA-Tg had high diagnostic performance, and the above two methods were recommended.
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Affiliation(s)
- Si-Rui Wang
- Department of Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases (First Affiliated Hospital, School of Medicine, Shihezi University), Shihezi, Xinjiang, China
| | - Qiao-Li Li
- Department of Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases (First Affiliated Hospital, School of Medicine, Shihezi University), Shihezi, Xinjiang, China
| | - Feng Tian
- Department of Neurology, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
| | - Jun Li
- Department of Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases (First Affiliated Hospital, School of Medicine, Shihezi University), Shihezi, Xinjiang, China
| | - Wen-Xiao Li
- Department of Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases (First Affiliated Hospital, School of Medicine, Shihezi University), Shihezi, Xinjiang, China
| | - Ming Chen
- Department of Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
| | - Tian Sang
- Department of Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases (First Affiliated Hospital, School of Medicine, Shihezi University), Shihezi, Xinjiang, China
| | - Chun-Li Cao
- Department of Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
| | - Li-Nan Shi
- Department of Ultrasound, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang, China
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases (First Affiliated Hospital, School of Medicine, Shihezi University), Shihezi, Xinjiang, China
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Liu N, Tang L, Chen Y, Wang Y, Huang W, Du Z, Shen Y, Wu Z, He T, Su G, Xie W, Chen Y. A Combination of Contrast-Enhanced Ultrasound and Thyroglobulin Level in Fine-Needle Aspirates Improves Diagnostic Accuracy for Metastatic Lymph Nodes of Papillary Thyroid Carcinoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2431-2443. [PMID: 34971466 DOI: 10.1002/jum.15926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) combined with thyroglobulin (Tg) levels in fine-needle aspirates (FNA) washout fluid (FNA-Tg) in diagnosing cervical lymph node (LN) metastasis in papillary thyroid cancer (PTC) patients. METHODS Data from 190 LNs in 167 patients suspected of metastasis from the US between November 2018 and September 2020 were included. All subjects underwent FNA, CEUS, and FNA-Tg examinations. The final outcomes were confirmed by histopathological or cytological examination or follow-up imaging. Data were analyzed using the Wilcoxon rank-sum or chi-squared test. The diagnostic efficacy of FNA, CEUS, and FNA-Tg in diagnosing LNs was compared. RESULTS A cutoff value of 6.15 ng/ml (AUC 0.925, 95% confidence interval (CI) 0.885-0.966) successfully identified metastatic LNs. FNA missed 58 LN metastases, of these, 94.8% (55/58) were correctly diagnosed using the combination of CEUS and FNA-Tg. FNA-Tg showed higher sensitivity (90.2%), NPV (86.1%) and accuracy (88.9%) than either FNA (48.2, 57.4 and 69.5%, respectively) or CEUS (82.1, 67.7 and 70.5%, respectively) alone. The combination of CEUS, FNA and FNA-Tg resulted in maximal sensitivity (100%) and NPV (100%) but reduced specificity (51.3%) and overall diagnostic accuracy (80.0%). After adding FNA-Tg to discordant samples between CEUS and FNA, 81.9% of LNs (77/94) were correctly diagnosed. CONCLUSIONS The combination of FNA, FNA-Tg and CEUS was found to be a promising imaging tool in detecting metastatic LNs in PTC patients.
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Affiliation(s)
- Naxiang Liu
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Lina Tang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yijie Chen
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yaoqin Wang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Weiqin Huang
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zhongshi Du
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Youhong Shen
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zhougui Wu
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Tongmei He
- Department of Pathology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Guangjian Su
- Department of Clinical Laboratory, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Wenting Xie
- Department of Ultrasound, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yunchao Chen
- Department of Ultrasound, Xiang'an Hospital of Xiamen University, Xiamen, China
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Wang Y, Duan Y, Li H, Yue K, Liu J, Lai Q, Zhou M, Ye B, Wu Y, Zhu J, Chen P, Jing C, Wu Y, Wang X. Detection of thyroglobulin in fine-needle aspiration for diagnosis of metastatic lateral cervical lymph nodes in papillary thyroid carcinoma: A retrospective study. Front Oncol 2022; 12:909723. [PMID: 36203449 PMCID: PMC9530248 DOI: 10.3389/fonc.2022.909723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We analysed the diagnostic performance of thyroglobulin in fine-needle aspiration (FNA-Tg) in the suspicious lateral cervical lymph nodes (CLNs) in patients with papillary thyroid cancer (PTC), proposed the best cutoff value and discussed the factors that may affect the diagnostic value of FNA-Tg. Methods In the present study, a retrospective analysis of 403 patients with PTC with 448 suspected lateral CLNs metastasis from October 2019 to May 2021 was performed. The cutoff value according to the receiver operating characteristic (ROC) curve was determined, and the Wilcoxon rank-sum test was used to evaluate the correlation between FNA-Tg and factors. Results According to the ROC curve, the cutoff value of FNA-Tg was 3.69 ng/ml (sensitivity, 92.48%; specificity, 75.00%). Patients who underwent total thyroidectomy were excluded. Compared with US and FNAC, the diagnostic performance of FNA-Tg was the greatest, especially for small CLNs (diameter ≤ 1 cm), cystic CLNs, and patients with Hashimoto’s thyroiditis (HT). Moreover, FNA-Tg levels were correlated with the presence of HT (p = 0.003), the anti-thyroglobulin antibody (Tg-Ab) (p < 0.001), the ratio of metastatic lateral CLNs (p = 0.004) and Tg assay kits (p < 0.001). Conclusions FNA-Tg measurement is sensitive enough for diagnosing lateral CLN metastases from PTC, but its diagnostic value is compromised by a number of factors.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Chao Jing
- *Correspondence: Xudong Wang, ; Yansheng Wu, ; Chao Jing,
| | - Yansheng Wu
- *Correspondence: Xudong Wang, ; Yansheng Wu, ; Chao Jing,
| | - Xudong Wang
- *Correspondence: Xudong Wang, ; Yansheng Wu, ; Chao Jing,
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Frasca F, Piticchio T, Le Moli R, Tumino D, Cannavò S, Ruggeri RM, Campennì A, Giovanella L. Early detection of suspicious lymph nodes in differentiated thyroid cancer. Expert Rev Endocrinol Metab 2022; 17:447-454. [PMID: 35993330 DOI: 10.1080/17446651.2022.2112176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Early identification of cervical lymph node (LN) metastases cervical lymph node metastases (CLNM) is crucial in the management of differentiated thyroid cancer differentiated thyroid cancer (DTC) as it influences the indication and the extent of surgery with an impact on the recurrence risk and overall survival. The present review focused on novel sensitive and specific diagnostic techniques, by searching through online databases like MEDLINE and Scopus up to February 2022. AREAS COVERED The techniques identified included contrast-enhanced ultrasound (CEUS), dosage of fragment 21-1 of cytokeratin 19 (CYFRA 21-1) in lymph node fine needle aspiration washout, sentinel LN biopsy (SNB), and artificial intelligence (AI) - deep learning applied to ultrasonography and computed tomography. These methods displayed widely varying sensitivity and specificity results, ranging from approximately 60-100%. This variability is mainly due to the operator's experience because of the great complexity of execution of these new techniques, which require a long-learning curve. EXPERT OPINION Despite the appearance of many candidate methods to improve the detection of metastatic lymph nodes, none seem to be clearly superior to the tools currently used in clinical practice and FNA-Tg measurement remains the more accurate tool to detect neck recurrences and CLNM from DTC.
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Affiliation(s)
- Francesco Frasca
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Tommaso Piticchio
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Rosario Le Moli
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Dario Tumino
- Endocrinology Section, Department of Clinical and Experimental Medicine, Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Salvatore Cannavò
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy
- Department of Human Pathology DETEV, University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Unit of Endocrinology, University Hospital of Messina, Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alfredo Campennì
- Unit of Nuclear Medicine, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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10
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Zhai L, Jiang W, Zang Y, Gao Y, Jiang D, Tian Q, Zhao C. Impact of Thyroid Tissue Status on the Cut-Off Value of Lymph Node Fine-Needle Aspiration Thyroglobulin Measurements in Papillary Thyroid Cancer. Br J Biomed Sci 2022; 79:10210. [PMID: 35996517 PMCID: PMC8915611 DOI: 10.3389/bjbs.2021.10210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022]
Abstract
Objective: To study the optimal cut-off value of thyroglobulin measurement in a fine-needle aspiration (FNA-Tg) in diagnosing malignant lymph nodes and benign lymph nodes (LNs) according to the thyroid tissue status. Methods: A total of 517 LNs were aspirated: 401 preoperative LNs, 42 LNs after subtotal thyroidectomy and 74 suspected LNs after total thyroidectomy. The cut-off value of FNA-Tg was obtained from receiver operating characteristic (ROC) analysis. The cut-off value with the best diagnostic performance was then obtained by comparing different cut-off values from other studies. Results: LN FNA-Tg levels differed between preoperative and total thyroid disease (p < 0.001) and subtotal thyroidectomy and total thyroidectomy (p = 0.03), but not between preoperative and subtotal thyroidectomy (p = 1.00). Accordingly, those 443 LNs with preoperative and subtotal thyroidectomy were compared to those 74 without thyroid tissue. The optimal cut-off value in thyroid tissue group was 19.4 ng/ml and the area under the ROC curve (AUC) was 0.95 (95% CI 0.92–0.97). The optimal cut-off value in thyroid tissue absence group was 1.2 ng/ml and the AUC was 0.93 (0.85–0.98). After the analysis and comparison of multiple cut-off values, the optimal diagnostic performance was still found to be 19.4 ng/ml and 1.2 ng/ml. Conclusion: The influential factors of FNA-Tg are still controversial, and the optimal cut-off value of FNA-Tg can be determined based on the presence or absence of thyroid tissue. FNA-Tg can be used as an important auxiliary method for diagnosing cervical metastatic LNs of thyroid cancer.
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Affiliation(s)
- L. Zhai
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Ultrasound, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - W. Jiang
- Health Management Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Y. Zang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Y. Gao
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - D. Jiang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Q. Tian
- Department of Laboratory Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - C. Zhao
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: C. Zhao,
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11
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Wu X, Liu Y, Li K, Yang Y, Lai P, Li J, Kou S. Predictive Value of FNA-Tg and TgAb in Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma. Technol Cancer Res Treat 2022; 21:15330338221127605. [PMID: 36128843 PMCID: PMC9500251 DOI: 10.1177/15330338221127605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: To analyze whether thyroglobulin (Tg) and anti-Tg antibody (TgAb) detection in fine-needle aspiration (FNA) of cervical lymph node (LN; LN-FNA-Tg and LN-FNA-TgAb) can predict LN metastasis and obtain the best cutoff value. Methods: The patients admitted to our hospital from January 2020 to March 2021 were prospectively enrolled. The LNs were sampled by FNA. All patients underwent thyroid surgery and neck dissection. LN-FNA-Tg, LN-FNA-TgAb, and blood Tg and TgAb were measured. The receiver operating characteristic curve analysis was used to determine the best cutoff points for positive LN. Results: There were 29 participants in the LN metastasis group and 42 in the nonmetastasis group. Compared with the nonmetastasis group, the participants in the metastasis group had higher LN-FNA-Tg (median: 1897 vs 7.74 ng/mL, P < .001), higher LN-FNA-TgAb (median: 15.65 vs 8.21 IU/mL, P < .001), and higher serum Tg (median: 25.4 vs 18.81 ng/mL); there were no differences in serum TgAb (median: 26.6 vs 28.6 IU/mL, P = .477). The best accuracy (87.5%) was observed with LN-FNA-Tg of >227.1 ng/mL, resulting in an area under the curve of 0.927, 84.5% sensitivity, and 89.5% specificity. LN-FNA-TgAb >10.85 IS/mL had an accuracy of 79.6%, sensitivity 64.8%, and specificity 89.5%. Serum Tg and TgAb had the lowest accuracy, with 64.2% and 57.4%, respectively, sensitivity of 53.5% and 67.6%, and specificity of 71.4% and 50.5%. Similar results were observed in first-operation participants and postoperative participants. Conclusions: LN-FNA-Tg has high accuracy, sensitivity, and specificity for detecting cervical LN in patients with papillary thyroid cancer.
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Affiliation(s)
- Xiaoli Wu
- Department of Ultrasonography, 159410Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Yan Liu
- Department of Ultrasonography, 159410Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Keji Li
- Department of Ultrasonography, 159410Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Yinghong Yang
- Department of General Surgery, 159410Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Ping Lai
- Department of Ultrasonography, 159410Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Jing Li
- Department of Laboratory Medicine, 159410Panzhihua Central Hospital, Panzhihua, Sichuan, China
| | - Sen Kou
- Department of Ultrasonography, 159410Panzhihua Central Hospital, Panzhihua, Sichuan, China
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12
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Kim K, Bae JS, Kim JS. Measurement of thyroglobulin level in lateral neck lymph node fine needle aspiration washout fluid in papillary thyroid cancer. Gland Surg 2021; 10:2686-2694. [PMID: 34733718 DOI: 10.21037/gs-21-366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/30/2021] [Indexed: 11/06/2022]
Abstract
Background Thyroglobulin (Tg) level of fine needle aspiration (FNA) washout fluid (FNA-Tg) is useful to detect cervical lymph node (LN) metastasis in patients with papillary thyroid cancer (PTC). The objective of this study was to determine appropriate cutoff values of serum Tg (S-Tg) and FNA-Tg levels for diagnosis of lateral neck LN metastasis and investigate their diagnostic performance. Methods A total of 169 patients with PTC who underwent modified radical neck dissection (mRND) were retrospectively reviewed at Seoul St. Mary's Hospital (Seoul, Korea) from December 2011 to September 2019. Diagnostic performance of FNA-Tg, Tg ratio (FNA-Tg level/S-Tg level), and FNA-Tg combined with Tg ratio was evaluated by correlation with FNA cytology results. Results FNA-Tg level ≥20 ng/mL exhibited 86.6% sensitivity, 66.7% specificity, and 81.7% accuracy. Tg ratio ≥3 exhibited lower sensitivity but higher specificity (82.7% and 73.8%, respectively) than FNA-Tg level ≥20 ng/mL. FNA-Tg level ≥20 ng/mL combined with Tg ratio ≥3 had 81.9% sensitivity, 80.5% accuracy, and an integrated area under the curve (iAUC) of 0.790. Conclusions Measurement of FNA-Tg level increases preoperative diagnostic accuracy for the detection of metastatic LNs in patients with PTC. Diagnostic accuracy is higher using a 20 ng/mL FNA-Tg cutoff level. Tg ratio is also valuable and FNA-Tg combined with Tg ratio shows promise.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
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13
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Wang Y, Duan Y, Zhou M, Liu J, Lai Q, Ye B, Liu D, Li L, Fang Y, Yue K, Jing C, Wu Y, Wang X. The diagnostic value of thyroglobulin in fine-needle aspiration of metastatic lymph nodes in patients with papillary thyroid cancer and its influential factors. Surg Oncol 2021; 39:101666. [PMID: 34634575 DOI: 10.1016/j.suronc.2021.101666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/24/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Thyroglobulin (Tg) measurement in fine-needle aspiration (FNA-Tg) has proved to be an excellent tool to identify metastatic cervical lymph nodes (CLN) before or after surgery for papillary thyroid cancer (PTC). The diagnostic value of FNA-Tg for metastatic CLN in PTC patients is higher than that of ultrasound (US) and fine-needle aspiration cytology (FNAC), especially for small or cystic LN. The combination of FNAC and FNA-Tg can provide nearly 100% diagnostic sensitivity and specificity for CLN metastasis. However, the cutoff values of FNA-Tg for metastatic CLN have not been standardized, and the reported cutoff values of FNA-Tg range from 0.2 ng/ml to 77 ng/ml because of the differences in study samples, Tg measurement methods, Tg assays kits, etc. Serum anti-thyroglobulin antibody level, serum thyroglobulin level, the presence or absence of thyroid glands, and the characteristics of CLN may be factors affecting the accuracy of FNA-Tg. This review summarizes the recent research on the application of FNA-Tg in the diagnosis of metastatic LN in PTC and provides a reliable basis for the clinical diagnosis of cervical lymph node metastasis.
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Affiliation(s)
- Yuxuan Wang
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Yuansheng Duan
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Mengqian Zhou
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Jin Liu
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Qingchuan Lai
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Beibei Ye
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Dandan Liu
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Linqi Li
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Yan Fang
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Kai Yue
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China
| | - Chao Jing
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China.
| | - Yansheng Wu
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China.
| | - Xudong Wang
- Department of Maxillofacial and Otorhinolaryngology Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, 300060, China.
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14
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Jia X, Wang Y, Liu Y, Wang X, Yao X, Tao R, Liu H, Yang A, Gao R. Thyroglobulin Measurement Through Fine-Needle Aspiration for Optimizing Neck Node Dissection in Papillary Thyroid Cancer. Ann Surg Oncol 2021; 29:88-96. [PMID: 34386915 PMCID: PMC8677638 DOI: 10.1245/s10434-021-10549-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 07/14/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Thyroglobulin measurement in fine-needle aspiration (FNA-Tg) is an additional diagnostic tool of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC). However, its performance as a preoperative indicator of lateral neck LNM in PTC is unclear. We evaluated the use of FNA cytology and FNA-Tg to detect neck LNM presurgery using a simple methodology, and established a cut-off value for diagnosing LNM in PTC. METHODS We performed a retrospective cohort study based on hospital records, including 299 FNA-Tg measurements from 228 patients with PTC. The cut-off value for FNA-Tg was obtained through a receiver operating characteristic (ROC) curve analysis. The relationships between various parameters and FNA-Tg were analyzed using Spearman's correlation. RESULTS Of 299 lymph nodes (LNs) from 228 patients following surgery, 151 were malignant and 148 were benign. The median FNA-Tg levels were 414.40 ng/mL and 6.36 ng/mL in the metastatic and benign LNs, respectively. An FNA-Tg cut-off value of 28.3 ng/mL had the best diagnostic performance (93.38% sensitivity, 70.27% specificity, area under the ROC curve [AUC] 0.868) in the whole cohort. The diagnostic value performed better in the lateral neck group (level II-V, n = 163) than in the central neck group (level VI, n = 136); in the lateral neck group, the sensitivity and specificity of the FNA-Tg cut-off (16.8 ng/mL) were 96.25% and 96.36%, respectively. CONCLUSIONS FNA-Tg is a useful technique for the diagnosis of LNM before surgery, especially in lateral neck dissection. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR1900028547.
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Affiliation(s)
- Xi Jia
- Department of Nuclear Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Yuanbo Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Yan Liu
- Department of Nuclear Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Xiang Wang
- Department of Ultrasound, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaobao Yao
- Department of Otorhinolaryngology - Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Runyi Tao
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hui Liu
- Biobank, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Aimin Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Rui Gao
- Department of Nuclear Medicine, The First Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China.
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15
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Song Y, Xu G, Wang T, Zhang B. Lateral neck multilevel fine-needle aspiration cytology and thyroglobulin estimation in papillary thyroid carcinoma. Laryngoscope Investig Otolaryngol 2021; 6:570-575. [PMID: 34195379 PMCID: PMC8223459 DOI: 10.1002/lio2.570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 04/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To assess the accuracy of preoperative ultrasound-guided multilevel fine-needle aspiration (FNA) cytology and thyroglobulin (Tg) estimation in mapping metastatic levels in the lateral neck, in patients with papillary thyroid carcinoma (PTC). METHODS Patients with PTC clinically metastasizing to the lateral neck who were initially treated at the Peking University Cancer Hospital from June 2018 to September 2020 were included. FNA was performed preoperatively in each suspicious neck level; cytological examination (FNA-C) and Tg measurement of the needle-washout fluid (FNA-Tg) were combined to determine metastasis. FNA-Tg cutoff value was calculated, and the accuracy of FNA at different levels were evaluated. RESULTS In total, 111 patients underwent 124 lymph node dissections. The best cutoff value of FNA-Tg for the diagnosis of metastatic level was 1.0 ng/mL. Multilevel FNA showed sensitivity, specificity, positive predictive value, and negative predictive value in predicting single-level metastasis of 100%, 61.0%, 43.9%, and 100%, respectively. In 64 (51.6%) cases, the involved levels diagnosed by FNA were consistent with that diagnosed by postoperative pathology. CONCLUSION FNA-Tg improves the diagnostic performance of FNA-C in lateral neck lymph node metastases. However, limited accuracy was obtained for preoperative multilevel FNA in predicting the extent of metastasis in the lateral compartment.
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Affiliation(s)
- Yuntao Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck SurgeryPeking University Cancer Hospital and InstituteBeijingChina
| | - Guohui Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck SurgeryPeking University Cancer Hospital and InstituteBeijingChina
| | - Tianxiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck SurgeryPeking University Cancer Hospital and InstituteBeijingChina
| | - Bin Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck SurgeryPeking University Cancer Hospital and InstituteBeijingChina
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16
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Diagnostic Algorithm for Metastatic Lymph Nodes of Differentiated Thyroid Carcinoma. Cancers (Basel) 2021; 13:cancers13061338. [PMID: 33809585 PMCID: PMC8000218 DOI: 10.3390/cancers13061338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Fine-needle aspiration cytology (FNAC) with measurement of thyroglobulin concentrations obtained through aspiration (FNA-Tg) is routinely used for the diagnosis of metastatic lymph nodes (LNs) from differentiated thyroid carcinomas. However, some areas of uncertainty remain, including the optimal FNA-Tg cutoff and its interpretation based on ultrasound (US) features. In this study, we evaluated the appropriate strategies for interpreting FNAC and FNA-Tg results based on the sonographic features of LNs. We confirmed that the malignancy rate of LNs found to be malignant by FNAC or elevated FNA-Tg was sufficiently high to be diagnosed as metastasis, regardless of the sonographic features. The malignancy rate of LNs with indeterminate or benign FNAC findings and low FNA-Tg were stratified according to their sonographic features. We propose a diagnostic algorithm, based on combined FNAC, FNA-Tg, and US features of LNs, for diagnosing metastatic LNs of differentiated thyroid carcinomas. Abstract We aimed to evaluate appropriate strategies for interpreting fine-needle aspiration cytology (FNAC) and thyroglobulin concentrations obtained through aspiration (FNA-Tg) results based on the sonographic features of lymph nodes (LNs). Consecutive patients who underwent ultrasound-guided FNAC and FNA-Tg for metastatic LNs from differentiated thyroid carcinomas (DTCs) from January 2014 to December 2018 were reviewed retrospectively. LNs were categorized sonographically as suspicious, indeterminate, or benign. The optimal FNA-Tg cutoff for metastatic LNs was evaluated preoperatively, after lobectomy, and after total thyroidectomy. The diagnostic performances of FNA-Tg, FNAC, and their combination were analyzed based on the sonographic features of LNs. The malignancy rates of LNs were analyzed based on the sonographic features, FNAC, and FNA-Tg results. Of the 1543 LNs analyzed, 528 were benign, whereas 1015 were malignant. FNA-Tg increased the sensitivity and accuracy of FNAC for LNs. The malignancy rate of LNs found to be malignant by FNAC or elevated FNA-Tg ranged from 82% to 100%, regardless of the sonographic features. The malignancy rate of LNs with indeterminate or benign FNAC findings and low FNA-Tg were stratified according to their sonographic features. We propose a diagnostic algorithm, based on combined FNAC, FNA-Tg, and ultrasound features of LNs, for diagnosing metastatic LNs of DTCs.
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17
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Liu RB, Zhou DL, Xu BH, Yang XH, Liu Q, Zhang X, Tang T, Ye ZL, Li Y. Comparison of the diagnostic performances of US-guided fine needle aspiration cytology and thyroglobulin measurement for lymph node metastases in patients with differentiated thyroid carcinoma: a meta-analysis. Eur Radiol 2020; 31:2903-2914. [PMID: 33125564 DOI: 10.1007/s00330-020-07400-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/24/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Ultrasound (US)-guided fine needle aspiration cytology (FNAC) and thyroglobulin measurement (FNA-Tg) are two common methods for confirming lymph node metastases (LNM) in patients with differentiated thyroid carcinoma (DTC). This study aimed at comparing the diagnostic performance of FNAC, FNA-Tg alone, and in combination by means of a meta-analysis. METHODS Eligible articles were selected according to predefined criteria, and their quality was evaluated as per the QUADAS-2 checklist. We calculated pooled sensitivity (Se), specificity (Sp), positive/negative likelihood ratio, and diagnostic odds ratio (DOR), and plotted the summary receiver operating characteristic (SROC) curve using the Meta-DiSc1.4 software. RESULTS Twenty-one studies pooling 1662 malignant and 1279 benign LNs from 2712 patients with DTC were included. The results showed that FNAC was more specific (pooled Sp, 0.98) while FNA-Tg was more sensitive (pooled Se, 0.94). FNAC and FNAC+FNA-Tg performed better postoperatively than FNA-Tg, while FNA-Tg performed better preoperatively. The combination of FNAC and FNA-Tg could achieve a better diagnostic performance than each alone (DOR 446.00, area under the curve [AUC] 0.9862), no matter preoperatively (DOR 378.14, AUC 0.9879) or postoperatively (DOR 788.72, AUC 0.9930). Besides, the combination of FNAC and FNA-Tg/serum-Tg ratio obtained a higher Sp (0.98) than the combination of FNAC and FNA-Tg. CONCLUSION The addition of FNA-Tg, especially the FNA-Tg/serum-Tg ratio, to FNAC could increase the diagnostic performance of LNM in both preoperative and postoperative patients with DTC. Since one test or test combinations could perform differently according to the clinical situation, the best-fitting test should be chosen accordingly. KEY POINTS • FNAC is more specific than FNA-Tg while FNA-Tg is more sensitive than FNAC. • The combination of FNAC and FNA-Tg could achieve a better diagnostic performance than either alone, no matter preoperatively or postoperatively. • The combination of FNAC and FNA-Tg/serum-Tg ratio could reach a higher Sp than the combination of FNAC and FNA-Tg.
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Affiliation(s)
- Rong-Bin Liu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510060, People's Republic of China.,Guangdong Provincial Key Laboratory of Malignant Tumor Gene Regulation and Target Therapy of Guangdong Higher Education Institutes, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Da-Lei Zhou
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Bo-Heng Xu
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xin-Hua Yang
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Qing Liu
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xiao Zhang
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Tao Tang
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Zu-Lu Ye
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Yue Li
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
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18
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Wang J, Jiang X, Xiao G, Zhou W, Hu Y. Excellent diagnostic performance of FNA-Tg in detecting lymph nodes metastases from papillary thyroid cancer. Future Oncol 2020; 16:2735-2746. [PMID: 32812450 DOI: 10.2217/fon-2020-0213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Thyroglobulin washout of fine needle aspiration (FNA-Tg) has proved to be useful in detecting lymph node metastases from papillary thyroid cancer; however, the influences of thyroid gland, Hashimoto thyroiditis, serum thyroglobulin (Tg) and anti-TG antibody on the diagnostic performance of FNA-Tg are controversial. Patients & methods: We retrospectively collected the FNA-Tg results of 176 preoperative or postoperative patients (356 lymph nodes) who finally were diagnosed with papillary thyroid cancer. The diagnostic abilities of FNA-Tg were evaluated and compared under different circumstances. Results: The diagnostic performance of FNA-Tg was uninfluenced irrespective of the status of thyroid gland or serum anti-TG antibody. However, high serum Tg was positively correlated with FNA-Tg (Exp(B) = 1.57; 95% CI: 1.209-2.309; p = 0.001). Conclusion: FNA-Tg was an excellent diagnostic tool, but it should be interpreted with caution only if serum Tg is higher than 10 ng/ml.
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Affiliation(s)
- Jiahui Wang
- Department of Head & Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China
| | - Xianfeng Jiang
- Department of Head & Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China
| | - Guizhou Xiao
- Department of Head & Neck Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China
| | - Weiping Zhou
- Department of Ultrasound, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China
| | - Yan Hu
- Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310020, PR China
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Yoon J, Yoon JH, Han K, Lee J, Kim EK, Moon HJ, Park VY, Kwak JY. Ultrasonography surveillance in papillary thyroid carcinoma patients after total thyroidectomy according to dynamic risk stratification. Endocrine 2020; 69:347-357. [PMID: 32449109 DOI: 10.1007/s12020-020-02347-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/09/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the role of neck US surveillance in patients with papillary thyroid carcinoma (PTC) after total thyroidectomy according to dynamic risk stratification (DRS) based on response to initial therapy. METHODS This retrospective study included 812 patients with PTC who underwent total thyroidectomy with prophylactic central neck dissection from January 2003 through February 2007. The relative risk of recurrence/persistence according to DRS was evaluated with the multivariable Cox regression proportional hazard model. RESULTS There were 132 men and 680 women. The mean age at surgery was 45.2 years. Postoperative US was used for DRS. According to DRS, 676 patients had excellent response, 78 indeterminate response, 40 biochemical incomplete response, and 18 structural incomplete response to initial therapy. Neck US was performed during follow-up and detected locoregional recurrences in 21 patients (2.6%): 12 with excellent response, 2 with biochemical incomplete response, and 7 with structural incomplete response according to DRS. Only 1 patient (0.1%) with excellent response had a locoregional recurrence that exceeded 8 mm in its shortest diameter, which is the size cut-off for diagnostic US fine-needle aspiration in suspicious lymph nodes. This patient did not develop biochemical abnormalities during follow-up. CONCLUSIONS Postoperative neck US surveillance after total thyroidectomy with prophylactic central neck dissection is not essential in PTC patients who show excellent response to initial therapy. Future studies are needed to verify the role of US surveillance in patients who receive variable degrees of treatments.
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Affiliation(s)
- Jiyoung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Jandee Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, 03722, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Vivian Youngjean Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.
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20
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Blažeković I, Romić M, Bosak Butković M, Šiško Markoš I, Gladić Nenadić V, Vidranski V, Petranović Ovčariček P, Krilić D, Varjačić T, Staničić J, Granić R, Punda M, Mihaljević I, Jukić T, Franceschi M. Thyroglobulin Measurement in Needle Aspiration for Detection of Recurrences and Neck Metastases in Patients with Differentiated Thyroid Carcinoma: Significance of Anti-Tg Antibodies. Acta Clin Croat 2020; 59:9-17. [PMID: 34219879 PMCID: PMC8212602 DOI: 10.20471/acc.2020.59.s1.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The worldwide incidence of differentiated thyroid cancer (DTC) has increased in recent decades, likely due to frequent use of cervical ultrasonography (US) and US-guided fine needle aspiration biopsy (FNA)., US is performed during follow-up after thyroidectomy, and US-guided FNA with cytology is used if suspicious cervical lymph nodes (LN) or thyroid bed masses are detected. Knowing that serum anti-Tg antibodies (sTgAb) affect the use of serum Tg (sTg) as a tumor marker, the aim of our study was to assess the usefulness of Tg determination in needle aspirates (FNA-Tg) in presence of sTgAb. This retrospective study included 149 patients with DTC and 159 aspirations of suspicious LN and thyroid bed masses. As expected, there was a negative correlation between sTg and sTgAb levels (p<0.05), while FNA-Tg levels had a positive correlation with FNA-TgAb levels (p<0.05). Furthermore, we found a positive correlation between sTg and FNA-Tg levels (p<0.05), but not between sTgAb and FNA-TgAb or sTgAb and FNA-Tg. In conclusion, these results show that FNA-Tg values were not affected by sTgAb and that FNA-Tg measurement were highly effective in detecting cervical DTC metastases. However, combined use with cytology is suggested for neck evaluation because cytology could reveal metastases from other tumor sites.
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Affiliation(s)
- Ivan Blažeković
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Matija Romić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Marija Bosak Butković
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Ines Šiško Markoš
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Vedrana Gladić Nenadić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Valentina Vidranski
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Petra Petranović Ovčariček
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Dražena Krilić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Tea Varjačić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Josip Staničić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Roko Granić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Marija Punda
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Ivan Mihaljević
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Tomislav Jukić
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
| | - Maja Franceschi
- 1Department of Oncology and Nuclear medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; 2School of Medicine, University of Zagreb, Zagreb, Croatia; 3Faculty of Medicine, University of Osijek, Osijek, Croatia; 4Department for Nuclear Medicine and Radiation Protection, Osijek University Hospital Center, Croatia
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Zhu XH, Zhou JN, Qian YY, Yang K, Wen QL, Zhang QH, Xia L, Ge MH, Sun CX. Diagnostic values of thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis diagnostic values of FNA-Tg. Endocr J 2020; 67:113-123. [PMID: 31723088 DOI: 10.1507/endocrj.ej18-0558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Thyroglobulin measurement in the needle washout after fine-needle aspiration (FNA-Tg) served as an important measurement for suspicious recurrent or metastatic lesions. We conducted a pooled analysis to evaluate the diagnostic accuracy of FNA-Tg and searched electronic databases for original articles in English from 1993 through 2017. Finally, a total of 22 studies containing 2,670 lymph nodes (LNs) that enrolled participants with suspicious neck LNs during thyroid nodule workup or papillary thyroid cancer (PTC) follow-up were included. In our analysis, the overall pooled sensitivity for FNA-Tg was 0.91 (95%CI: 0.87-0.93), specificity was 0.94 (95% CI: 0.91-0.96). Meta regression revealed that the cutoff value and status of serum Tg were sources of heterogeneity for sensitivity, and the cutoff value was source of heterogeneity for specificity. Additionally, the cutoff value and status of serum Tg were sources of heterogeneity in the joint model. Subgroup analysis about cut-off value showed that the choice of 1 ng/mL had highest sensitivity, 40 ng/mL had highest specificity. At last, we arrived at the conclusion that FNA-Tg measurement had high specificity and sensitivity in the early detection of LNs metastases from PTC by our meta-analysis. The technique was simple and could be recommended to apply in any FNA facility, especially when LN were small-sized. Significantly, a better standardization of criteria for FNA-Tg detection and cutoff value was required to provide useful data and to improve management of PTC patients in the future.
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Affiliation(s)
- Xu-Hang Zhu
- Department of Head and Neck Surgery and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Jing-Nan Zhou
- Department of Equipment, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Yang-Yang Qian
- Department of Head and Neck Surgery and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Ke Yang
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Qing-Liang Wen
- Department of Head and Neck Surgery and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Qi-Hong Zhang
- Department of Head and Neck Surgery and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou, 310022, People's Republic of China
| | - Liang Xia
- Department of Neurosurgeon, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Ming-Hua Ge
- Department of Head and Neck Surgery, Thyroid Surgery of People's Hospital of Zhejiang Province and Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
| | - Cai-Xing Sun
- Department of Neurosurgeon, Zhejiang Cancer Hospital, Hangzhou 310022, People's Republic of China
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22
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Jiang HJ, Hsiao PJ. Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review. Kaohsiung J Med Sci 2020; 36:236-243. [PMID: 31909556 DOI: 10.1002/kjm2.12173] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/01/2019] [Indexed: 11/06/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) generally has a good prognosis, but disease recurs in 25% to 30% of PTC patients and significantly reduces the survival rate. Lymph node metastasis (LNM) is reported in 20% to 50% of PTC patients, mainly in the neck, and 20% originates from recurrence. LNM of papillary thyroid carcinoma are a plausible prognostic factor to determine disease recurrence. Currently, fine needle lymph node aspiration for cytology (LN-FN-cytology) is the best modality to diagnose LNM but is limited by diagnostic sensitivity and sample error. Fine needle lymph node aspiration for thyroglobulin measurement (LN-FNA-Tg) could offer a reliable and quantitative diagnostic method for LNM. The combination of LN-FNA-cytology and LN-FNA-Tg could achieve almost 100% diagnostic sensitivity and specificity for LNM. Both treatment guidelines of the American Thyroid Association and European Thyroid Association recommend LN-FNA-Tg to diagnose LNM after total thyroidectomy. Diagnostic accuracy of the LN-FNA-Tg depends on optimal equipment, scanning protocol, skill, and experience of operators. Normal saline is mainly used for aspiration needle wash-out and buffer solution. And radioimmunoassay or immunoradiometric assay are widely used for the LN-FNA-Tg measurement. So far, there is no consensus about the diagnostic threshold of LN-FNA-Tg for positive LNM, but high LN-FNA-Tg, especially higher than 10 ng/mL, strongly favors LNM.
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Affiliation(s)
- He-Jiun Jiang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pi-Jung Hsiao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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23
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Xu Y, Wu D, Wu W, Jiang J, Xi C, Ye N, Wang Y, Xu X. Diagnostic value of cytology, thyroglobulin, and combination of them in fine-needle aspiration of metastatic lymph nodes in patients with differentiated thyroid cancer: A systematic review and network meta-analysis. Medicine (Baltimore) 2019; 98:e17859. [PMID: 31702649 PMCID: PMC6855606 DOI: 10.1097/md.0000000000017859] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To investigate the diagnostic performance of cytology (fine-needle aspiration cytology [FNAC]), thyroglobulin (fine-needle aspiration thyroglobulin [FNA-Tg]), and combination of them in the washout of fine-needle aspiration for those patients who have suspicious metastatic lymph nodes of differentiated thyroid cancer. METHODS Databases, including PubMed, EMbase, Web of Science and Cochrane Library were searched up to June 2019. The quality assessment of diagnostic accuracy scale-2 was used to conduct quality assessments, and publication bias was evaluated using the Deeks funnel plot. STATA version 14.0 was used to perform the meta-analysis. RESULTS A total of 2257 patients with 2786 samples of suspicious metastatic lymph nodes of differentiated thyroid cancer were included in the meta-analysis. The results showed that the diagnostic value for detecting lymph node metastasis of differentiated thyroid cancer was as follows: combination of FNAC and FNA-Tg > FNA-Tg > FNAC. All differences of superiority among them are statistically significant. The sensitivity of the combination was 0.968 (95% confidence interval [CI]: 0.942-0.983), the specificity was 0.932 (95% CI: 0.856-0.969), the diagnostic score was 6.036 (95% CI: 4.892-7.181), the diagnostic odds ratio was 418.424 (95% CI: 133.167-1314.729), and the score of summary receiver operating characteristic was 0.99 (95% CI: 0.97-0.99). CONCLUSIONS The combination of FNAC and FNA-Tg is an excellent procedure in diagnosis of lymph nodes metastasis of patients with differentiated thyroid cancer, which should be highly recommended.
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Affiliation(s)
- Yixin Xu
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou
| | - Dapeng Wu
- Department of Endoscopy, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing
| | - Wenting Wu
- Department of Intensive Care Unit, Changzhou No.2 Hospital Affiliated to Nanjing Medical University
| | - Jian Jiang
- Department of Endocrine, Changzhou No.4 Hospital Affiliated to Suzhou University, Changzhou, Jiangsu, China
| | - Cheng Xi
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou
| | - Nianyuan Ye
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou
| | - Yibo Wang
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou
| | - Xuezhong Xu
- Department of General Surgery, Wujin Hospital Affiliated to Jiangsu University, Changzhou
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The Transareola Endoscopic Approach Yields Adequate Oncological Dissection as Open Approach in the Treatment of Papillary Thyroid Carcinoma. Surg Laparosc Endosc Percutan Tech 2019; 29:489-492. [PMID: 31584497 DOI: 10.1097/sle.0000000000000729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to evaluate and discuss whether the transareola endoscopic surgery has similar outcome outcomes to open surgery in the treatment of papillary thyroid carcinoma (PTC). METHOD A total of 102 patients with PTC were enrolled in this study. Among them, 53 patients were treated by transareola endoscopic surgery (endoscopic group) and 49 patients were treated by open surgery (open group). Some specific factors, including thyroglobulin (Tg), radioactive iodine uptake (RAIU), postoperative nuclide imaging in thyroid area, postoperative nuclide imaging of lymph nodes suspicious for metastasis (PNILNSM), etc. were analyzed and compared between the 2 groups. RESULTS There were no significant differences between the 2 groups regarding body mass index (22.9±3.4 vs. 24.0±3.3, P=0.103), operation time (173.3±43.2 vs. 158.8±47.9 min, P=0.110), intraoperative blood loss (41.8±19.4 vs. 35.8±31.0 mL, P=0.251, P=0.251), tumor diameter (19.0±6.8 vs. 20.2±7.2 mm, P=0.400), and overall complications (11.3% vs. 10.2%, P=0.868). No significant difference was found in the specific factors between the 2 groups concerning RAIU-2h/24h (2.44±1.34 vs. 2.58±1.65%/2.83±3.75 vs. 2.35±3.44%, P=0.646/ P=0.506), number of dissected lymph nodes (4.4±1.4 vs. 4.6±1.5, P=0.595), Tg before radioiodine therapy (4.46±5.50 vs. 5.60±8.36; P=0.495), Tg after radioiodine therapy (1.03±1.93 vs. 1.11±1.61, P=0.812, P=0.812), postoperative nuclide imaging in thyroid area (1.76±1.50 vs. 2.19±1.85 cm, P=0.195), PNILNSM before radioiodine (none: 79.2% vs. 83.7%, P=0.566; central: 17.0% vs. 12.2%, P=0.653; lateral: 1.9% vs. 4.1%, P=0.450; central+lateral: 1.9% vs. 0%, P=1.000), and PNILNSM after radioiodine (none: 94.3% vs. 95.9%, P=0.111; central: 3.8% vs. 2.0%, P=1.000; lateral: 0 vs. 2.0%, P=0.480; central+lateral: 1.9% vs. 0%, P=1.000). CONCLUSIONS Transareola endoscopic total thyroidectomy and central lymph nodes dissection are safe and effective. According to the evaluated postoperative specific factors, this technique achieves similar outcomes to open surgery in selected patients with PTC.
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Back K, Kim JS, Kim JH, Choe JH. Superior Located Papillary Thyroid Microcarcinoma is a Risk Factor for Lateral Lymph Node Metastasis. Ann Surg Oncol 2019; 26:3992-4001. [DOI: 10.1245/s10434-019-07587-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Indexed: 12/11/2022]
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Kim MJ, Lee SG, Kim K, Lee CR, Kang SW, Lee J, Nam KH, Chung WY, Jeong JJ. Current trends in the features of male thyroid cancer: Retrospective evaluation of their prognostic value. Medicine (Baltimore) 2019; 98:e15559. [PMID: 31083219 PMCID: PMC6531171 DOI: 10.1097/md.0000000000015559] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study aimed to compare the clinicopathologic characteristics and oncologic outcomes of papillary thyroid cancer (PTC) patients according to sex. Then, we validated prognostic variables to determine whether sex is a significant prognostic factor for PTC.Between January 2007 and December 2010, 1232 men and 7276 women PTC patients underwent surgery. The patient characteristics and 5-year oncologic outcomes were compared. The stepwise Cox proportional hazards model determined the significance of survival variables.Men PTC patients had more lymph node (LN) metastases than women, both in the total (P < .0001) and hemithyroidectomy (P < .0001) patients. Men and women showed similar 5-year recurrence-free survivals, both in total (P = .815) and hemithyroidectomy (P = .148) patients. The tumor size and the number of positive central nodes were associated with tumor recurrence, but not sex.Sex was not an independent prognostic factor for tumor recurrence. Multicenter clinical studies with long-term follow-ups are needed to validate these results.
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Affiliation(s)
- Min Jhi Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seul Gi Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwangsoon Kim
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Cho Rok Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Wook Kang
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jandee Lee
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Kee-Hyun Nam
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Woong Youn Chung
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Ju Jeong
- Department of Surgery, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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CYFRA 21-1 in Lymph Node Fine Needle Aspiration Washout Improves Diagnostic Accuracy for Metastatic Lymph Nodes of Differentiated Thyroid Cancer. Cancers (Basel) 2019; 11:cancers11040487. [PMID: 30959821 PMCID: PMC6520940 DOI: 10.3390/cancers11040487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 01/05/2023] Open
Abstract
Fine needle aspiration cytology (FNAC) and washout thyroglobulin (Tg) measurements are the standard for evaluating a metastatic lymph node (LN) in thyroid cancer. However, patients rarely benefit from these procedures due to false results. This study aims to identify a reliable biomarker that significantly improves the diagnosis of metastatic LNs, in addition to FNAC and washout Tg. This study analyzed 130 LNs that were suspected to have metastases on thyroid ultrasonography, from June 2016 to December 2017. All subjects underwent FNAC, washout Tg measurements and a new biomarker, washout Cytokeratin fragment 21-1 (CYFRA 21-1) measurement. The final LN outcomes were confirmed by surgical histology, repeat FNAC, or follow-up image. The diagnostic values of the presence of washout CYFRA 21-1 for diagnosing metastatic LNs were evaluated according to final LN outcomes. Among the 130 LNs, 42 were metastatic lesions and 88 were benign. The washout CYFRA 21-1 levels were significantly higher in metastatic LNs than in benign LNs. In contrast to the findings of washout Tg, washout CYFRA 21-1 showed little overlap between benign and malignant LNs, and its diagnostic cutoff values were not affected by surgery. The combinations of FNAC and washout CYFRA 21-1 showed higher sensitivity (91.9%), specificity (96.5%), negative predictive value (98.8%), and diagnostic accuracy (94.2%) than FNAC with washout Tg. The combination of FNAC, washout Tg, and washout CYFRA 21-1 showed the best sensitivity (98.8%). When washout CYFRA 21-1 was applied to the discordant results that were observed between FNAC and washout Tg, 20 of 22 LNs were correctly diagnosed. Washout CYFRA 21-1 measurements in thyroid LNs provide a diagnostic modality.
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Depciuch J, Stanek-Widera A, Skrzypiec D, Lange D, Biskup-Frużyńska M, Kiper K, Stanek-Tarkowska J, Kula M, Cebulski J. Spectroscopic identification of benign (follicular adenoma) and cancerous lesions (follicular thyroid carcinoma) in thyroid tissues. J Pharm Biomed Anal 2019; 170:321-326. [PMID: 30954022 DOI: 10.1016/j.jpba.2019.03.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 01/03/2023]
Abstract
Thyroid follicular nodules are quite common in the population, however only a small proportion is malignant. Thyroid cancer differs from adenoma by features of cellular atypia, angioinvasiveness and possibility of metastasis via blood vessels mainly in the lungs and bones. Pathomorphological examination of the postoperative material plays a significant role in the diagnosis of cystic thyroid lesions. De facto, there is no possibility to determine with certainty whether the lesion is benign or malignant before surgery, therefore new methods are being sought to meet clinical needs. The study aimed to investigate if Fourier-transform infrared spectroscopy (FTIR) spectroscopy and Raman spectroscopy combined with multidimensional analysis can be a useful tool in distinguishing between thyroid adenomas and carcinomas. The obtained results indicate quantitative and qualitative alterations within proteins and fats derived from patients' tissues samples. Raman spectroscopy additionally shows significant changes in the amount of tissue collagen due to the pathogenic process. In the spectra of the second FTIR derivative, shifts of vibrations corresponding to the β-sheet and α-helix structure are observed towards the lower rates of wave numbers in the case of neoplastic tissues. Using the leave-one-out cross-validation, sensitivity and specificity calculated with Principal Component Analysis-Linear Discriminant Analysis (PCA-LDA) clearly shows the possibility to distinguish between pathologically changed and normal thyroid tissue as well as differentiate follicular thyroid adenoma (FTA) from widely invasive follicular thyroid carcinoma (WI-FTC) tissues.
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Affiliation(s)
- Joanna Depciuch
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342, Krakow, Poland.
| | - Agata Stanek-Widera
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, PL-44101, Gliwice, Poland
| | - Dominika Skrzypiec
- Center for Innovation and Transfer of Natural Sciences and Engineering Knowledge, University of Rzeszow, PL-35959, Rzeszow, Poland
| | - Dariusz Lange
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, PL-44101, Gliwice, Poland
| | - Magdalena Biskup-Frużyńska
- Department of Tumor Pathology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, PL-44101, Gliwice, Poland
| | - Krzysztof Kiper
- Faculty of Medicine, University of Rzeszow, PL-35959, Rzeszow, Poland
| | | | - Monika Kula
- Polish Academy of Sciences, The Franciszek Górski Institute of Plant Physiology, Niezapominajek 21, 30239, Krakow, Poland
| | - Jozef Cebulski
- Center for Innovation and Transfer of Natural Sciences and Engineering Knowledge, University of Rzeszow, PL-35959, Rzeszow, Poland
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Jee HG, Kim BA, Kim M, Yu HW, Choi JY, Kim SJ, Lee KE. Expression of SLC5A5 in Circulating Tumor Cells May Distinguish Follicular Thyroid Carcinomas from Adenomas: Implications for Blood-Based Preoperative Diagnosis. J Clin Med 2019; 8:jcm8020257. [PMID: 30781659 PMCID: PMC6406463 DOI: 10.3390/jcm8020257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/25/2022] Open
Abstract
Preoperative diagnosis of thyroid nodules reduces unnecessary surgery. Circulating tumor cells (CTCs) may contain information of primary tumor(s). We asked whether the peripheral blood expression of genes specific for circulating tumor cells (CTCs) differentiates benign thyroid nodules from malignant nodules. Peripheral blood mononuclear cells from thyroid nodule patients (n = 20) were isolated preoperatively and the expression of seven CTC-associated genes was measured in patients with thyroid nodule(s) (n = 20). Among the tested genes, the expression of SLC5A5 and LGALS3 were validated in a larger number of patients (n = 64) and our results show that SLC5A5 expression differentiated follicular adenomas from follicular carcinomas (area under the curve (AUC) = 0.831). The expression of SLC5A5 in CTCs may preoperatively distinguish thyroid follicular adenomas from follicular carcinomas.
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Affiliation(s)
- Hyeon-Gun Jee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.
- Healthcare Innovation Park, Seoul National University Bundang Hospital, Seoungnam 13605, Korea.
| | - Byoung-Ae Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Minjun Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul 03080, Korea.
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea.
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul 03080, Korea.
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Treatment of differentiated thyroid cancer: can endoscopic thyroidectomy via a chest-breast approach achieve similar therapeutic effects as open surgery? Surg Endosc 2018; 32:4749-4756. [PMID: 29761277 DOI: 10.1007/s00464-018-6221-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/09/2018] [Indexed: 01/08/2023]
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Algeciras-Schimnich A. Thyroglobulin measurement in the management of patients with differentiated thyroid cancer. Crit Rev Clin Lab Sci 2018; 55:205-218. [DOI: 10.1080/10408363.2018.1450830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Seo JW, Han K, Lee J, Kim EK, Moon HJ, Yoon JH, Park VY, Baek HM, Kwak JY. Application of metabolomics in prediction of lymph node metastasis in papillary thyroid carcinoma. PLoS One 2018; 13:e0193883. [PMID: 29509799 PMCID: PMC5839571 DOI: 10.1371/journal.pone.0193883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/20/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The aim of this study was to find useful metabolites to predict lymph node (LN) metastasis in patients with papillary thyroid cancer (PTC) through a metabolomics approach and investigate the potential role of metabolites as a novel prognostic marker. MATERIALS AND METHODS Fifty-two consecutive patients (median age: 41.5 years, range 15-74 years) were enrolled who underwent total thyroidectomy and central LN dissection with or without lateral LN dissection in Severance Hospital between October 2013 and July 2015. The study specimens were provided by the Severance Hospital Gene Bank, and consisted of PTC from each patient. The specimens were prepared for proton nuclear magnetic resonance (1H-NMR) spectroscopy. Spectral data by 1H-NMR spectroscopy were acquired, processed, and analyzed. Patients were grouped in three ways, according to the presence of LN metastasis, central LN metastasis and lateral LN metastasis. Chi-square test and the student t-test were used to analyze categorical variables and continuous variables, respectively. The Mann-Whitney U test was used for univariate analysis of metabolites. Orthogonal projections to latent structure discriminant analysis (OPLS-DA) was used for multivariate analysis to discriminate metabolic differences between the two groups. RESULTS Among 52 patients, 32 had central LN metastasis and 19 had lateral LN metastasis. No clinical or histopathological characteristic was significantly different for all comparisons. On univariate analysis, no metabolite showed significant difference for all comparisons. On multivariate analysis, OPLS-DA did not discriminate the presence and absence of LN metastasis. Lactate was found to be the most promising metabolite. CONCLUSIONS No metabolite could discriminate the presence of LN metastasis. However, lactate was found to be the most promising metabolite for discrimination. Further studies with larger sample sizes are needed to elucidate significant metabolites which can indicate the presence of LN metastasis in patients with PTC.
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Affiliation(s)
- Ji Won Seo
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jandee Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeon-Man Baek
- Gachon University, Department of Biomedical Engineering, Incheon, Republic of Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science Yonsei University College of Medicine, Seoul, Republic of Korea
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Benmoussa JA, Chen K, Najjar S, Applewhite M, Warshaw J. Lateral neck Cystic Mass: The Role of Thyroglobulin Measurement in Fine Needle Aspiration. Endocr Pract 2018; 24:767. [PMID: 29498919 DOI: 10.4158/ep-2018-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jamila A Benmoussa
- From the 1Department of Endocrinology, Albany Medical Center, Albany, New York
| | - Karin Chen
- From the 1Department of Endocrinology, Albany Medical Center, Albany, New York
| | - Saleh Najjar
- Department of Pathology, Albany Medical Center, Albany, New York
| | | | - James Warshaw
- From the 1Department of Endocrinology, Albany Medical Center, Albany, New York
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Eun NL, Son EJ, Kim JA, Gweon HM, Kang JH, Youk JH. Comparison of the diagnostic performances of ultrasonography, CT and fine needle aspiration cytology for the prediction of lymph node metastasis in patients with lymph node dissection of papillary thyroid carcinoma: A retrospective cohort study. Int J Surg 2018; 51:145-150. [PMID: 29337176 DOI: 10.1016/j.ijsu.2017.12.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the diagnostic performances of ultrasonographic (US) findings, computed tomography (CT) findings and fine needle aspiration cytology (FNAC) for the prediction of cervical lymph node (LN) metastases of papillary thyroid carcinoma (PTC) to determine which LN should be dissected. METHODS 376 LNs in 302 patients who underwent both US-guided skin surface LN markings and CT before LN dissection were analyzed retrospectively. Indications for LN dissection were suspicious US findings of LN metastases (n = 300), suspicious CT findings (n = 67) or surgeon's request (n = 9). Diagnostic performances of US, CT and FNAC (including thyroglobulin (Tg)) were evaluated. The correlations of suspicious US, CT finding or malignant FNAC with the size, number and the presence of extranodal extension of metastatic LNs were analyzed. RESULTS US indication of LN dissection was significantly correlated with malignancy (p < .0001). Values of area under the curve of highly suspicious US findings and FNAC+Tg were significantly higher than that of CT (0.786, 0.878, 0.585, p < .0001, respectively). Suspicious US, CT findings and malignant FNAC+Tg were significantly associated with the largest size of metastatic LNs (p = .003, p = .0003, and p = .0006, respectively) and total number of metastatic LNs (p = .007, p = .038, and p = .005, respectively). CONCLUSION The diagnostic performance of US or FNAC was superior to CT and highly suspicious US findings could be complimentary to FNAC results in predicting LN metastases of PTC. LN dissection should be performed for the LNs with any suspicious US findings or malignant FNAC results rather than LNs with only suspicious CT findings.
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Affiliation(s)
- Na Lae Eun
- Institution: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea.
| | - Eun Ju Son
- Institution: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea.
| | - Jeong-Ah Kim
- Institution: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea.
| | - Hye Mi Gweon
- Institution: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea.
| | - Jung-Hyun Kang
- Institution: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea.
| | - Ji Hyun Youk
- Institution: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, 06273, Seoul, Republic of Korea.
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You J, Chen J, Xiang F, Song Y, Khamis S, Lu C, Lv Q, Zhang Y, Xie M. The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules. J Med Ultrason (2001) 2017; 45:251-259. [PMID: 28905143 DOI: 10.1007/s10396-017-0819-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/28/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed at evaluating the diagnostic performance of quantitative shear wave elastography (SWE) in differentiating metastatic cervical lymph nodes from benign nodes in patients with thyroid nodules. METHODS One hundred and forty-one cervical lymph nodes from 39 patients with thyroid nodules that were diagnosed as papillary thyroid cancer had been imaged with SWE. The shear elasticity modulus, which indicates the stiffness of the lymph nodes, was measured in terms of maximum shear elasticity modulus (maxSM), minimum shear elasticity modulus (minSM), mean shear elasticity modulus (meanSM), and standard deviation (SD) of the shear elasticity modulus. RESULTS All the patients underwent thyroid surgery, 50 of the suspicious lymph nodes were resected, and 91 lymph nodes were followed up for 6 months. The maxSM value, minSM value, meanSM value, and SD value of the metastatic lymph nodes were significantly higher than those of the benign nodes. The area under the curve of the maxSM value, minSM value, meanSM value, and SD value were 0.918, 0.606, 0.865, and 0.915, respectively. CONCLUSIONS SWE can differentiate metastasis from benign cervical lymph nodes in patients with thyroid nodules, and the maxSM, meanSM, and SD may be valuable quantitative indicators for characterizing cervical lymph nodes.
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Affiliation(s)
- Jun You
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Juan Chen
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Feixiang Xiang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yue Song
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Simai Khamis
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chengfa Lu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yanrong Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China. .,Department of Radiology, Neuroradiology Section, Stanford University, Palo Alto, CA, USA.
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Aydin C, Dellal FD, Tam AA, Ogmen B, Kilicarslan A, Topaloglu O, Ersoy R, Cakir B. Comparative analysis of diagnostic adequacy rate between aspiration and nonaspiration techniques of fine-needle cytology in patients with thyroid cancer and ultrasonographically suspicious cervical lymph nodes. Diagn Cytopathol 2017; 45:889-894. [DOI: 10.1002/dc.23793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Cevdet Aydin
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Fatma Dilek Dellal
- Department of Endocrinology and Metabolism; Ataturk Training and Research Hospital; Ankara Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Berna Ogmen
- Department of Endocrinology and Metabolism; Ataturk Training and Research Hospital; Ankara Turkey
| | - Aydan Kilicarslan
- Department of Pathology; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism; Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
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Trimboli P, D'Aurizio F, Tozzoli R, Giovanella L. Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids. Clin Chem Lab Med 2017; 55:914-925. [PMID: 27802177 DOI: 10.1515/cclm-2016-0543] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
Abstract
Different imaging tools, circulating endocrine markers, and fine-needle aspiration (FNA) cytology are of great importance in the diagnosis and follow-up of different thyroid and parathyroid diseases. Sometimes, however, they are conflicting or inconclusive: interestingly, measuring endocrine markers (i.e. thyroglobulin, calcitonin, parathyroid hormone) in fluids from FNA proved to be a very useful complementary diagnostic tool in such cases. The determination of endocrine markers in fluids other than serum/plasma has been developed in the last years. Although studies have reported overall satisfactory results, a good standardization of procedures has not yet been reached, and further efforts should be made in order to better define pre-analytical, analytical, and post-analytical aspects. Here we reviewed critically the literature on the measurement of FNA endocrine markers, focusing on laboratory issues, such as preparation of the sample, choice of solution, and technical features of determination of these markers. Indeed, information for use of FNA-Tg, FNA-CT, and FNA-PTH in clinical practice was also provided.
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Zhao H, Wang Y, Wang MJ, Zhang ZH, Wang HR, Zhang B, Guo HQ. Influence of presence/absence of thyroid gland on the cutoff value for thyroglobulin in lymph-node aspiration to detect metastatic papillary thyroid carcinoma. BMC Cancer 2017; 17:296. [PMID: 28454525 PMCID: PMC5410021 DOI: 10.1186/s12885-017-3296-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Thyroglobulin measurement with fine-needle aspiration (Tg-FNA) is a sensitive method for detecting metastatic papillary thyroid carcinoma (PTC). However, the diagnostic threshold is not well established and the influence of the thyroid gland on the cutoff value is also controversial. In this study, patients were classified into two groups according to the presence or absence of thyroid tissue, to determine an appropriate cutoff value for clinical practice. Methods Patients with a history of thyroid nodules or surgery for PTC and with enlarged cervical lymph nodes on an FNA examination were enrolled for Tg-FNA detection. Results One hundred ninety-six lymph nodes (189 patients) were included: 100 from preoperative patients, 49 from patients treated with partial thyroid ablation, and 47 from patients with total thyroid ablation. In 149 lymph nodes from patient with thyroids, the cutoff value for Tg-FNA was 55.99 ng/mL (sensitivity, 95.1%; specificity, 100%), whereas in 47 lymph nodes from patients without a thyroid, it was 9.71 ng/mL (sensitivity, 96.7%; specificity, 100%). Thus, the cutoff value for Tg-FNA was higher in patients with thyroids than in patients without thyroids. Conclusions The cutoff value for Tg-FNA is influenced by residual thyroid tissue, and a higher cutoff value is recommended for patients with thyroids than for patients without thyroids. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3296-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Huan Zhao
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Nanli Panjiayuan Lane, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Yong Wang
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Min-Jie Wang
- Department of Clinical Library, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhi-Hui Zhang
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Nanli Panjiayuan Lane, Chaoyang District, Beijing, 100021, People's Republic of China
| | - Hai-Rui Wang
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Bing Zhang
- Department of Head and Neck Surgery, Peking University Cancer Hospital, Beijing, China
| | - Hui-Qin Guo
- Department of Pathology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Nanli Panjiayuan Lane, Chaoyang District, Beijing, 100021, People's Republic of China.
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Wu H, Zhang B. Serum thyroglobulin or thyroglobulin in fine-needle aspiration washout of metastatic lymph nodes: which one should we have confidence in for the surveillance of thyroid carcinoma? J Am Soc Cytopathol 2017; 6:66-72. [PMID: 31042636 DOI: 10.1016/j.jasc.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 06/09/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the diagnostic performance of serum thyroglobulin (S-Tg), thyroglobulin in fine-needle aspiration washout (FNA-Tg) and fine-needle aspiration cytology (FNAC) in the detection of lateral metastatic lymph nodes (LNs) in patients with thyroid carcinoma. METHODS The study included 19 lateral metastatic LNs from 19 patients with thyroid carcinoma who underwent FNAC for the suspicion of metastatic disease on ultrasonogrphy (US). The S-Tg, FNA-Tg, FNAC, and histopathological results were correlated. RESULTS Compared with S-Tg, both FNAC and FNA-Tg showed higher sensitivity (89.5%, 89.5% versus 68.4%, respectively) and accuracy (89.5%, 89.5% versus 68.4%, respectively). The combined use of FNAC and FNA-Tg or FNAC and S-Tg showed superior diagnostic power. CONCLUSIONS S-Tg measurement is a less reliable method for follow-up in patients with thyroid carcinoma in comparison with FNA-Tg. For patients with negative S-Tg but suspicious features in US, FNAC combined with FNA-Tg is strongly recommended to confirm the diagnosis.
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Affiliation(s)
- Hongxun Wu
- Department of Ultrasound, Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine (Key Laboratory of Nuclear Medicine, Ministry of Health/Jiangsu Key Laboratory of Molecular Nuclear Medicine), Wuxi, China.
| | - Bingjie Zhang
- Department of Ultrasound, Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine (Key Laboratory of Nuclear Medicine, Ministry of Health/Jiangsu Key Laboratory of Molecular Nuclear Medicine), Wuxi, China
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Martins-Costa MC, Maciel RMB, Kasamatsu TS, Nakabashi CCD, Camacho CP, Crispim F, Ikejiri ES, Mamone MCO, Andreoni DM, Biscolla RPM. Clinical impact of thyroglobulin (Tg) and Tg autoantibody (TgAb) measurements in needle washouts of neck lymph node biopsies in the management of patients with papillary thyroid carcinoma. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:108-114. [PMID: 28225995 PMCID: PMC10118871 DOI: 10.1590/2359-3997000000241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/26/2016] [Indexed: 11/22/2022]
Abstract
Objectives The presence of thyroglobulin (Tg) in needle washouts of fine needle aspiration biopsy (Tg-FNAB) in neck lymph nodes (LNs) suspected of metastasis has become a cornerstone in the follow-up of patients with papillary thyroid carcinoma (PTC). However, there are limited data regarding the measurement of anti-Tg antibodies in these washouts (TgAb-FNAB), and it is not clear whether these antibodies interfere with the assessment of Tg-FNAB or whether there are other factors that would more consistently justify the finding of low Tg-FNAB in metastatic LNs. Materials and methods We investigated 232 FNAB samples obtained from suspicious neck LNs of 144 PTC patients. These samples were divided according to the patient's serum TgAb status: sTgAb- (n = 203 samples) and sTgAb+ (n = 29). The TgAb-FNAB levels were measured using two different assays. Tg-FNAB was also measured using two assays when low levels (< 10 ng/mL) were identified in the first assay of the metastatic LNs from the sTgAb+ samples. Results The TgAb-FNAB results were negative in both assays in all samples. Low levels of Tg-FNAB were identified in 11/16 of the metastatic LNs of the sTgAb+ patients and 16/63 of the sTgAb- patients (p < 0.05) using assay 1. The measurement of the Tg-FNAB levels using assay 2 indicated additional metastases in 5 LNs of the sTgAb+ patients. Conclusions Factors other than the presence of TgAb-FNAB may contribute to the higher number of metastatic LNs with undetectable Tg-FNAB in the sTgAb+ group. In addition, the measurement of Tg-FNAB using different assays was useful to enhance the diagnosis of metastatic LNs, particularly when cytological and Tg-FNAB results are discordant.
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Affiliation(s)
- M Cecilia Martins-Costa
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Departamento de Medicina, Universidade de Fortaleza (Unifor), Fortaleza, CE, Brasil
| | - Rui M B Maciel
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Teresa S Kasamatsu
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil
| | - Claudia C D Nakabashi
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
| | - Cleber P Camacho
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil
| | - Felipe Crispim
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil
| | - Elza S Ikejiri
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil
| | - M Conceição O Mamone
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil
| | - Danielle M Andreoni
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil
| | - Rosa Paula M Biscolla
- Centro de Doenças da Tireoide e Laboratório de Endocrinologia Molecular e Translacional, Divisão de Endocrinologia, Departamento de Medicina, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM- -Unifesp), São Paulo, SP, Brasil.,Centro de Doenças da Tireoide, Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE), São Paulo, SP, Brasil.,Fleury Medicina e Saúde, São Paulo, SP, Brasil
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Konca Degertekin C, Yalcin MM, Cerit T, Ozkan C, Kalan I, Iyidir OT, Altinova AE, Akturk M, Toruner F, Akin M, Cakir N. Lymph node fine-needle aspiration washout thyroglobulin in papillary thyroid cancer: Diagnostic value and the effect of thyroglobulin antibodies. Endocr Res 2016; 41:281-289. [PMID: 26905960 DOI: 10.3109/07435800.2016.1141936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Thyroglobulin (Tg) assessment in the needle washout after fine-needle aspiration biopsy (FNAB) of a suspicious neck lymph node (LN) is known to improve the diagnostic accuracy in patients with papillary thyroid cancer (PTC). However, there is still controversy on the best diagnostic cut-off levels for FNAB-Tg and whether thyroglobulin antibody (TgAb) positivity affects FNAB-Tg. The objectives of this study were to determine (i) the diagnostic power of different cut-offs for FNAB-Tg and (ii) if serum TgAb(+) negatively affects the FNAB-Tg evaluation. METHODS This was a retrospective cohort study analyzing PTC patients with suspicious neck LNs, in a university hospital setting, from October 2009 to October 2013. In total, 103 patients with PTC (226 LNs) undergoing ultrasound-guided FNAB for LNs were included. Cytology and FNAB-Tg levels were compared in reference to LN histopathology and the effect of TgAb(+) on FNAB-Tg levels was evaluated. RESULTS The diagnostic accuracies of FNAB-Tg cut-off of 1 and 10 ng/mL were 94.1% and 88.2%, respectively. Raising the cut-off from 1 to 10 ng/mL led to decreased sensitivity rates (91.9% vs. 83.9%). The receiver operating characteristic curve analysis demonstrated that the best FNAB-Tg cut-off was 1.2 ng/mL. There were no LNs with an FNAB-Tg ≥ 10 ng/mL that turned out to be cytologically or histopathologically benign. FNAB-Tg levels of the histopathologically malignant LNs were similar between TgAb (+) and TgAb (-) patients (p = 0.546). Serum Tg predicted FNAB-Tg levels above 1 ng/mL (p = 0.002) and FNAB-Tg predicted malignant histopathology (p = 0.004), both independently of the TgAb status of the patient. CONCLUSIONS FNAB-Tg ≥ 1 ng/mL has a superior diagnostic power, irrespective of TgAb (+), in PTC patients with suspected LN involvement.
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Affiliation(s)
- Ceyla Konca Degertekin
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Mehmet Muhittin Yalcin
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Turgay Cerit
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Cigdem Ozkan
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Isilay Kalan
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Ozlem Turhan Iyidir
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Alev Eroglu Altinova
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Mujde Akturk
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Fusun Toruner
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Murat Akin
- b Department of General Surgery , Gazi University Faculty of Medicine , Ankara , Turkey
| | - Nuri Cakir
- a Department of Endocrinology and Metabolism , Gazi University Faculty of Medicine , Ankara , Turkey
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Kim MJ, Lee J, Lee SG, Choi JB, Kim TH, Ban EJ, Lee CR, Kang SW, Jeong JJ, Nam KH, Jo YS, Chung WY. Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 2016; 31:1599-1606. [PMID: 27572060 DOI: 10.1007/s00464-016-5146-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Robotic modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported to be a safe and meticulous technique in patients with papillary thyroid carcinoma (PTC) and lateral neck node metastasis (N1b). Few studies, however, have attempted to assess the long-term oncologic outcomes of robotic MRND in these patients. This study aimed to compare perioperative and 5-year oncologic outcomes of robotic MRND with conventional open procedures in patients with N1b PTC. METHODS Between September 2007 and February 2010, 193 patients with N1b PTC underwent total thyroidectomy and MRND by a single surgeon. Of these, 42 (21.8 %) underwent robotic procedures and 151 (78.2 %) underwent conventional open procedures. All patients received 3.7- to 5.5-GBq radioactive iodine (RAI) ablation, post-therapy whole-body scans (TxWBSs), and diagnostic WBS (DxWBSs) during follow-up. An exact 1:3 matching for age and stage was performed to minimize selection bias, and perioperative and 5-year oncologic outcomes were compared in the matched groups. RESULTS The mean follow-up period was 66.0 months (range 60-90 months). Number of retrieved cervical lymph nodes (LNs) (p = .102) and postoperative ablation success rates (p = .864) were similar between the two groups. TSH-suppressed serum Tg concentrations after 5 years (0.7 ± 1.5 vs. 2.4 ± 14.1 ng/ml; p = .471) and recurrence rates in the robotic and open groups (1/41 [2.4 %] vs. 3/102 [2.9 %]; p = .864) were similar for the 5-year follow-up period. Four patients experienced recurrence: Three exhibited regional lymph node metastasis, and one showed bilateral lung metastases. CONCLUSION The perioperative and 5-year oncologic outcomes were similar after robotic and conventional open MRND. Large, prospective randomized controlled trials with long-term follow-up data are needed to validate these results.
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Affiliation(s)
- Min Jhi Kim
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jandee Lee
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seul Gi Lee
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Bum Choi
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jeong Ban
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Wook Kang
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young Suk Jo
- Department of Internal Medicine, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
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Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract 2016; 22:622-39. [PMID: 27167915 DOI: 10.4158/ep161208.gl] [Citation(s) in RCA: 688] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).
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44
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Patel NU, McKinney K, Kreidler SM, Bieker TM, Russ P, Roberts K, Glueck DH, Albuja-Cruz M, Klopper J, Haugen BR. Ultrasound-based clinical prediction rule model for detecting papillary thyroid cancer in cervical lymph nodes: A pilot study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:143-151. [PMID: 26402153 DOI: 10.1002/jcu.22309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 08/06/2015] [Accepted: 08/22/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To identify sonographic features of cervical lymph nodes (LNs) that are associated with papillary thyroid cancer (PTC) and to develop a prediction model for classifying nodes as metastatic or benign. METHODS This retrospective study included the records of postthyroidectomy patients with PTC who had undergone cervical ultrasound and LN biopsy. LN location, size, shape, hilum, echopattern, Doppler flow, and microcalcifications were assessed. Model selection was used to identify features associated with malignant LNs and to build a predictive, binary-outcome, generalized linear mixed model. A cross-validated receiver operating characteristic analysis was conducted to assess the accuracy of the model for classifying metastatic nodes. RESULTS We analyzed records from 71 LNs (23 metastatic) in 44 patients (16 with PTC). The predictive model included a nonhomogeneous echopattern (odds ratio [OR], 5.73; 95% confidence interval [CI], 1.07-30.74; p = 0.04), microcalcifications (OR, 4.91; 95% CI, 0.91-26.54; p = 0.06), and volume (OR, 2.57; 95% CI, 0.66-9.99; p = 0.16) as predictors. The model had an area under the curve of 0.74 (95% CI, 0.60-0.85), sensitivity of 65% (95% CI, 50% to 78%), and specificity of 85% (95% CI, 73% to 94%) at the Youden optimal cut point of 0.38. CONCLUSIONS Nonhomogeneous echopattern, microcalcifications, and node volume were predictive of malignant LNs in patients with PTC. A larger sample is needed to validate this model.
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Affiliation(s)
- Nayana U Patel
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Kristin McKinney
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Sarah M Kreidler
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | | | - Paul Russ
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Katherine Roberts
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, 80045
| | - Deborah H Glueck
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, 80045
| | - Maria Albuja-Cruz
- Department of GI Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Joshua Klopper
- Department of Medicine, Division of Endocrinology, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, 80045
| | - Bryan R Haugen
- Department of Medicine, Division of Endocrinology, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, 80045
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Improvement in the Detection of Cystic Metastatic Papillary Thyroid Carcinoma by Measurement of Thyroglobulin in Aspirated Fluid. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8905916. [PMID: 26881230 PMCID: PMC4736329 DOI: 10.1155/2016/8905916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/16/2015] [Indexed: 01/29/2023]
Abstract
Cystic change in metastatic lymph nodes of papillary thyroid carcinoma (PTC) is a diagnostic challenge for fine needle aspiration (FNA) because of the scant cellularity. The aim of this study was to evaluate the measurement of thyroglobulin in fine needle aspirate (Tg-FNA) for detecting metastatic PTC in patients with cystic neck lesions and to validate the optimal cutoff value of Tg-FNA. A total of 75 FNA specimens of cystic lesions were identified, including 40 of metastatic PTC. Predetermined threshold levels of 0.04 (minimum detection level), 0.9, 10.0, and 77.0 ng/mL (maximum normal serum-Tg level) were used to evaluate the diagnostic accuracy of Tg-FNA for metastatic PTC detection. The areas under the receiver operating characteristic curve for diagnosing metastatic PTC of Tg-FNA values of 0.04, 0.9, 10.0, and 77.0 ng/mL were 0.5 (95% confidence interval [CI], 0.382–0.618), 0.645 (95% CI, 0.526–0.752), 0.945 (95% CI, 0.866–0.984), and 0.973 (95% CI, 0.907–0.996), respectively. With a cutoff value of 77.0 ng/mL, the combination of Tg-FNA and FNA cytology showed superior diagnostic power (97.5% sensitivity and 100% specificity) compared to FNA cytology alone (80% sensitivity and 100% specificity). We recommend a Tg-FNA cutoff of 77.0 ng/mL, the maximum normal serum-Tg level, for cystic neck lesions.
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Yoon JH, Lee HS, Kim EK, Youk JH, Kim HG, Moon HJ, Kwak JY. Short-term Follow-up US Leads to Higher False-positive Results Without Detection of Structural Recurrences in PTMC. Medicine (Baltimore) 2016; 95:e2435. [PMID: 26735548 PMCID: PMC4706268 DOI: 10.1097/md.0000000000002435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the value of the annual follow-up neck ultrasonography (US) for postoperative surveillance in patients with papillary thyroid microcarcinoma (PTMC). This retrospective study has been approved by our institutional review board (IRB) with waiver for informed consent. A total of 375 patients diagnosed as PTMCs, who underwent total thyroidectomy with radioiodine remnant ablation were included, to identify the recurrence rate and the false-positive rate of annual ultrasound. The number, interval, and the results of follow-up US or fine needle aspiration were obtained from electronic medical records. Four (1.1%, 4/375) recurrences were found 3 years after the initial treatment, and only 1 patient (0.3%, 1/375) had a metastatic lymph node larger than 8 mm in the shortest diameter on US found 7.6 years after initial treatment with biochemical abnormalities. Cumulative risk of having at least 1 false-positive exam was 8.3% by the 8th US, and 8.1% by the 8-9 year follow-up. Cox multivariate regression showed shorter interval of follow-up US and presence of lymph node metastasis at initial surgery are independent predictors affecting the cumulative false-positive results (hazard ratio [HR], 0.60; 95% confidence interval [CI]: 0.49-0.73; P < 0.001 and HR, 2.19; 95% CI: 1.01-4.75; P = 0.048, respectively). Short-term follow-up US can result in higher cumulative false-positive results without detection of meaningful recurrences in patients with PTMCs who do not have biochemical abnormalities.
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Affiliation(s)
- Jung Hyun Yoon
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (JHY, E-KK, HJM, JYK); Department of Research Affairs, Biostatistics Collaboration Unit (HSL); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (JHY); and Department of Radiology, Ajou University School of Medicine, Suwon, Korea (HGK)
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Lai XJ, Zhang B, Jiang YX, Li JC, Zhao RN, Yang X, Zhang Q, Zhang XY, Li WB, Zhu SL. High Risk of Lateral Nodal Metastasis in Lateral Solitary Solid Papillary Thyroid Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:75-81. [PMID: 26497768 DOI: 10.1016/j.ultrasmedbio.2015.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/26/2015] [Accepted: 09/04/2015] [Indexed: 06/05/2023]
Abstract
We explored the relationship between ultrasonic intra-thyroidal location and neck node metastasis pattern in solitary solid papillary thyroid cancer (PTC). Data on 186 patients were retrospectively reviewed. The association between several characteristics and neck node metastasis pattern were analyzed. Among the 186 thyroid nodules, age ≥45 y (p = 0.005), mass size ≥2 cm (p = 0.001), presence of calcifications (p < 0.001) and lateral nodal metastasis (p = 0.001) were significantly related to central nodal metastasis in multivariate analysis. Mass size ≥2 cm (p = 0.046) and central nodal metastasis (p = 0.002) were significantly related to lateral nodal metastasis in multivariate analysis. Location of an intra-thyroidal solitary solid PTC located non-adjacent to the trachea (lateral) was significantly related to lateral nodal metastasis (p = 0.043) compared with location of an intra-thyroidal solitary solid PTC adjacent to the trachea (medial or isthmus). Lateral lesions have a high risk of lateral nodal metastasis in solitary solid PTC.
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Affiliation(s)
- Xing-Jian Lai
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Bo Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Yu-Xin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China.
| | - Jian-Chu Li
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Rui-Na Zhao
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Xiao Yang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Qing Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Xiao-Yan Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Wen-Bo Li
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
| | - Shen-Ling Zhu
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing, China
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Aydin C, Ozdemir D, Sacikara M, Polat SB, Yazgan AK, Turkolmez S, Onal ED, Ersoy R, Cakir B. A new approach for standardization and increased accuracy of lymph node washout thyroglobulin in patients with differentiated thyroid carcinoma. Diagn Cytopathol 2015; 44:177-86. [DOI: 10.1002/dc.23414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/25/2015] [Accepted: 11/25/2015] [Indexed: 01/31/2023]
Affiliation(s)
- Cevdet Aydin
- School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University; Ankara
| | - Didem Ozdemir
- School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University; Ankara
| | - Muhammed Sacikara
- School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University; Ankara
| | - Sefika Burcak Polat
- School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University; Ankara
| | - Aylin Kilic Yazgan
- School of Medicine, Department of Pathology, Ankara Yildirim Beyazit University; Ankara
| | - Seyda Turkolmez
- School of Medicine, Department of Nuclear Medicine, Ankara Yildirim Beyazit University; Ankara
| | - Eda Demir Onal
- School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University; Ankara
| | - Reyhan Ersoy
- School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University; Ankara
| | - Bekir Cakir
- School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University; Ankara
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49
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Shi JH, Xu YY, Pan QZ, Sui GQ, Zhou JP, Wang H. The value of combined application of ultrasound-guided fine needle aspiration cytology and thyroglobulin measurement for the diagnosis of cervical lymph node metastases from thyroid cancer. Pak J Med Sci 2015; 31:1152-5. [PMID: 26649004 PMCID: PMC4641273 DOI: 10.12669/pjms.315.6726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The aim of this study was to explore the diagnostic value of ultrasound-guided (US-guided) fine-needle aspiration cytology (FNAC), thyroglobulin measurement on fine-needle aspiration (FNA-Tg), combined US-guided FNAC, and the ratio between FNA-Tg and serum Tg (FNA-Tg/serum Tg) for patients with cervical lymph node (CLN) metastases from thyroid carcinoma. Methods: We selected 148 patients with thyroid cancer with suspicious CLN metastases who met the inclusion criteria. FNAC findings, FNA-Tg levels, and serum Tg levels were evaluated before surgical treatment. The results of FNAC and FNA-Tg from CLNs were analyzed retrospectively. Results: Ninety-four of 148 cases were metastatic and 54 were benign. The sensitivity, specificity, and accuracy of FNAC were 68.1%, 100.0%, and 79.7%, respectively. The sensitivity, specificity, and accuracy of FNA-Tg/serum Tg were 91.5%, 88.9%, and 90.5%, respectively. The sensitivity, specificity, and accuracy of FNA-Tg [10 ng/mL] were 98.9%, 68.5%, and 87.8%, respectively. The sensitivity, specificity, and accuracy of combined US-guided FNAC and FNA-Tg/serum Tg were 95.7%, 96.3%, and 95.9%, respectively. There was a statistically significant difference between FNAC and combined US-guided FNAC and FNA-Tg/serum Tg for sensitivity, specificity, and accuracy (P < 0.05). Conclusion: The method of FNA-Tg/serum Tg is sensitive enough for diagnosing CLN metastases from thyroid cancer. The combined application of US-guided FNAC and FNA-Tg/serum Tg contributes to improving the accuracy of diagnosing CLN metastases in patients with thyroid cancer.
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Affiliation(s)
- Jia-Hong Shi
- Jia-hong Shi, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Ying-Ying Xu
- Ying-ying Xu, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Qi-Zheng Pan
- Qi-zheng Pan, Department of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Guo-Qing Sui
- Guo-qing Sui, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Jian-Ping Zhou
- Jian-ping Zhou, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Hui Wang
- Hui Wang, Department of Ultrasonography, China-Japan Union Hospital of Jilin University, Changchun 130033, China
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50
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Lee JH, Lee HC, Yi HW, Kim BK, Bae SY, Lee SK, Choe JH, Kim JH, Kim JS. Influence of thyroid gland status on the thyroglobulin cutoff level in washout fluid from cervical lymph nodes of patients with recurrent/metastatic papillary thyroid cancer. Head Neck 2015; 38 Suppl 1:E1705-12. [PMID: 26614648 DOI: 10.1002/hed.24305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 08/13/2015] [Accepted: 09/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The influence of serum thyroglobulin (Tg) and thyroidectomy status on Tg in fine-needle aspiration cytology (FNAC) washout fluid is unclear. METHODS A total of 282 lymph nodes were prospectively subjected to FNAC, fine-needle aspiration (FNA)-Tg measurement, and frozen and permanent biopsies. We evaluated the diagnostic performance of several predetermined FNA-Tg cutoff values for recurrence/metastasis in lymph nodes according to thyroidectomy status. RESULTS The diagnostic performance of FNA-Tg varied according to thyroidectomy status. The optimized cutoff value of FNA-Tg was 2.2 ng/mL. However, among FNAC-negative lymph nodes, the FNA-Tg cutoff value of 0.9 ng/mL showed better diagnostic performance in patients with a thyroid gland. An FNA-Tg/serum-Tg cutoff ratio of 1 showed the best diagnostic performance in patients without a thyroid gland. CONCLUSION Applying the optimal cutoff values of FNA-Tg according to thyroid gland status and serum Tg level facilitates the diagnostic evaluation of neck lymph node recurrences/metastases in patients with papillary thyroid carcinoma (PTC). © 2015 Wiley Periodicals, Inc. Head Neck 38: E1705-E1712, 2016.
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Affiliation(s)
- Jun Ho Lee
- Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyun Chul Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha Woo Yi
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bong Kyun Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Youn Bae
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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