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Kravchenko T, Chen V, Hsu D, Manzella A, Kheng M, Laird AM, Simon M, Trooskin S, Beninato T. Which Ultrasound Characteristics Predict Lymphatic Spread of Papillary Thyroid Cancer? J Surg Res 2024; 299:263-268. [PMID: 38781736 DOI: 10.1016/j.jss.2024.04.047] [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: 10/08/2023] [Revised: 04/02/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The 2015 American Thyroid Association guidelines recommend lymph node mapping US in patients with definitive cytological evidence of thyroid cancer. Suspicious lymph node features on imaging including enlarged size (>1 cm in any dimension), architectural distortion, loss of fatty hilum, and microcalcifications often prompt evaluation with fine needle aspiration. There is no universally agreed upon model for determining which ultrasound characteristics most strongly correlate with metastatic disease. METHODS A retrospective review of patients with confirmed papillary thyroid cancer (PTC) undergoing lymph node mapping ultrasound from 2013 to 2019 was performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated for each individual ultrasound characteristic as well as for characteristic combinations. RESULTS Data from 119 lymph nodes were included. Malignant lymph nodes were more likely to be enlarged (71% versus 61%, P < 0.001) and to have each individual suspicious feature. Loss of fatty hilum had the highest sensitivity (89%) but was not specific (19%) for metastatic disease. Architectural distortion was found to have the highest specificity (87%). A combination of the four features was found to have higher specificity (97%) and PPV (88%) than any individual feature or combination of two/three features. CONCLUSIONS A combination of four sonographic features correlates with metastatic PTC to lymph nodes and has the highest specificity and PPV for malignancy. A risk stratification model based on these features may lead to better classification of ultrasound findings in PTC patients with concern for nodal metastases.
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Affiliation(s)
| | - Vivian Chen
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Daniel Hsu
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Alexander Manzella
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Marin Kheng
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Amanda M Laird
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey; Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Mitchell Simon
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Stanley Trooskin
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Toni Beninato
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey; Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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2
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Chen J, Lin Z, Xu B, Lu T, Zhang X. The efficacy and assessment value of the level of thyroglobulin wash-out after fine-needle aspiration cytodiagnosis in the evaluation of lymph node metastasis in papillary thyroid carcinoma. World J Surg Oncol 2024; 22:149. [PMID: 38840197 PMCID: PMC11151531 DOI: 10.1186/s12957-024-03430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy and clinical value of US, FNAC,FNA-Tg and FNAC + FNA-Tg, as well as the cutoff values of FNA-Tg to evaluate LN metastasis. METHODS We analyzed the diagnostic value of different US signs, the efficiency of US, FNAC, FNA-Tg and FNAC + FNA-Tg among the LN- and LN + groups, and the cutoff value of FNA-Tg to evaluate LN metastasis. We punctured LNs multiple times and measured the levels of FNA-Tg. Furthermore, the LNs were marked with immunohistochemical Tg and LCA to distinguish the presence of Tg in the para-cancerous tissue of the LNs. RESULTS The s-Tg and FNA-Tg of the LN + group were higher than those of the LN- group (P = 0.018, ≤ 0.001). The LN + group had more abnormal US signs than the LN- group. The cutoff value of FNA-Tg was 3.2 ng/mL. US had a high sensitivity (92.42), but the specificity was not satisfactory (55.1). FNA-Tg had a higher sensitivity (92.42 vs. 89.39), specificity (100 vs. 93.88), and accuracy (92.42 vs. 83.27) than FNAC. However, the sensitivity of FNAC + FNA-Tg increased further, while the specificity and accuracy decreased slightly. The presence of Tg in the normal lymphocytes adjacent to the cancer was confirmed. CONCLUSION Ultrasonography provides a noninvasive, dynamic, multidimensional assessment of LNs. With a cutoff value of 3.2 ng/mL, FNA-Tg has higher accuracy and a lower false-negative rate than various single diagnoses. However, FNAC combined with FNA-Tg does not cause additional pain to patients and offers a higher diagnostic efficacy and clinical value.
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Affiliation(s)
- Jie Chen
- Thyroid and Breast Surgery, Department of General Surgery, Wanbei Coal and Power Group General Hospital affiliated With Bengbu Medical University, Su Zhou, Anhui Province, China
| | - Zongwu Lin
- Thyroid and Breast Surgery, Department of General Surgery, Wanbei Coal and Power Group General Hospital affiliated With Bengbu Medical University, Su Zhou, Anhui Province, China
| | - Bo Xu
- Thyroid and Breast Surgery, Department of General Surgery, Wanbei Coal and Power Group General Hospital affiliated With Bengbu Medical University, Su Zhou, Anhui Province, China
| | - Tianwen Lu
- Thyroid and Breast Surgery, Department of General Surgery, Wanbei Coal and Power Group General Hospital affiliated With Bengbu Medical University, Su Zhou, Anhui Province, China
| | - Xinghai Zhang
- Thyroid and Breast Surgery, Department of General Surgery, Wanbei Coal and Power Group General Hospital affiliated With Bengbu Medical University, Su Zhou, Anhui Province, China.
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Liu H, Shi Y, Zhan J, Liu Y, Zhou J, Su B, Chen Y, Wang L, Chen L. ENST00000438158 aids ultrasound for predicting lymph node metastasis and inhibits migration and invasion of papillary thyroid carcinoma cells. Drug Discov Ther 2023; 17:26-36. [PMID: 36261389 DOI: 10.5582/ddt.2022.01061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cervical lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC) is directly associated with clinical management and prognosis. In this study, we aimed to evaluate the value of conventional ultrasound (US) combined with ENST00000438158 in predicting CLNM of PTC. Fourty-nine PTC patients underwent US examination and US-guided fine needle aspiration (FNA). ENST00000438158 expression in FNA cytological specimens and PTC cell lines was detected using real-time reverse transcription polymerase chain reaction (qRT-PCR). The role of ENST00000438158 expression in the proliferation, migration, invasion, apoptosis, and cell cycle of PTC cells was investigated by Cell Counting Kit-8 (CCK8) and clone formation experiments, transwell assay, and flow cytometry, respectively. Calcification, capsule contact, and low ENST00000438158 expression were independently associated with PTC with CLNM (all p < 0.05). The combination of multiple US features was more valuable than a single US feature in predicting CLNM in PTC. Adding ENST0000438158 to US greatly improved the value of differentiation of PTC with or without CLNM. In conclusion, ENST00000438158 is a potential molecular marker for predicting CLNM in PTC. ENST00000438158 combined with US features is highly valuable for predicting CLNM in PTC.
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Affiliation(s)
- Hui Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yixin Shi
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Biao Su
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,The Academy of Integrative Medicine of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
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Lin YY, Zhu Y, Wang YX, Wang B. Horner Syndrome subsequent to ultrasound-guided cervical lymph node fine-needle aspiration - A case report and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:203-209. [PMID: 36165415 DOI: 10.1002/jcu.23349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/22/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Horner Syndrome (HS) is characterized by symptoms of ipsilateral miosis, ptosis, enophthalmos, and facial anhidrosis, which is caused by the damaged oculosympathetic pathway. HS is rarely reported as postoperative complications of fine-needle aspiration (FNA). We report a case of HS triggered by Ultrasound-guided FNA during thyroid cancer management and conducted the literature review. A 31-year-old male with differentiated thyroid cancer underwent total thyroidectomy and regional lymph node dissection as well as radioactive iodine ablation, presented with persistently elevated tumor marker of thyroglobulin and suspicious left level IV and V cervical lymph nodes by neck ultrasound. Ultrasound-guided left cervical lymph nodes FNA for cellular diagnosis was performed, and typical manifestations of HS appeared immediately after the procedure. Subsequent ultrasound evaluation of the same area demonstrated a subtle strip of the hypo-echogenic area in the superior pole of the suspected level IV structure, suggesting sympathetic ganglia with the visible originating nerve fiber on the superior pole. All of the patient's symptoms of HS were resolved 2 months after the incidence. Cervical sympathetic ganglia can be similar in size, shape, and ultrasound characteristics to a malignant lymph node. Thorough ultrasound examination by directly comparing the potential ganglia with a typical malignant lymph node, and paying attention to any potential root fibers on the target is key to avoiding ganglia injury before the neck invasive procedures.
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Affiliation(s)
- Yu Yang Lin
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Ying Zhu
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Yi Xuan Wang
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Bei Wang
- The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
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Stanyakina EE, Romanov IS, Gogieva EK, Ignatova AV, Alymov YV, Ilkaev KD. The effectiveness of the method for determining the level of thyroglobulin in needle washouts of fine-needle aspiration biopsy in the differential diagnosis of metastases of highly differentiated thyroid cancer in the lymph nodes of the neck. HEAD AND NECK TUMORS (HNT) 2022. [DOI: 10.17650/2222-1468-2022-12-3-10-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction. Thyroid cancer is one of the most common malignant neoplasms of the endocrine system. well-differentiated thyroid cancer constitutes about 90 % of all malignant tumors of the thyroid gland. Despite growing morbidity and high incidence of this pathology, in case of timely diagnosis and treatment well-differentiated thyroid cancer has favorable prognosis.Aim. using clinical examples, to demonstrate the possibility of thyroglobulin measurement in needle washouts of fineneedle aspiration biopsy in the detection of cervical metastases of highly differentiated thyroid cancer.Materials and methods. five patients (2 patients with combined oncological pathology, 2 patients with nodes in the thyroid gland, 1 patient after a thyroidectomy) with cervical adenopathy measured the level of thyroglobulin in the wash out fluid of lymph-nodes biopsy using the immunoradiometric method using the commercial kits of the Institute of Isotopes-IRmA (Hungary).Results. Cervical metastases of highly differentiated thyroid cancer were detected or excluded by the determination of fine-needle aspiration biopsy in patients with non-informational cytological studies. The determination of fineneedle aspiration biopsy is a useful diagnostic method in the differential diagnosis of cervical metastases in patients who have other morphological forms of cancer in addition to well-differentiated thyroid cancer, as well as for the differential diagnosis of cervical adenopathy in patients with a history of highly differentiated thyroid cancer.Conclusion. Determination of thyroglobulin level in puncture needle washout is a simple and useful diagnostic method for differential diagnosis of metastases in lymph nodes of the neck in patients with several morphological forms of malignant tumors.
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Affiliation(s)
- E. E. Stanyakina
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - I. S. Romanov
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - E. Kh. Gogieva
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - A. V. Ignatova
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; Рeoples’ Friendship University of Russia
| | - Yu. V. Alymov
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - K. D. Ilkaev
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
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Can Age at Diagnosis and Sex Improve the Performance of the American Thyroid Association Risk Stratification System for Prediction of Structural Persistent and Recurrent Disease in Patients With Differentiated Thyroid Carcinoma? A Multicenter Study. Endocr Pract 2021; 28:30-35. [PMID: 34508902 DOI: 10.1016/j.eprac.2021.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/09/2021] [Accepted: 09/01/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although the age at diagnosis has been suggested as a major determinant of disease-specific survival in the recent TNM staging system, it is not included in the recent American Thyroid Association (ATA) guidelines to estimate the risk of recurrence. Nevertheless, the effect of sex on differentiated thyroid carcinoma (DTC) recurrence is controversial. Therefore, this multicenter study was conducted to assess whether age at diagnosis and sex can improve the performance of the ATA 3-tiered risk stratification system in patients with DTC with at least 5 years of follow-up. METHODS In this study, the computer-recorded data of the patients diagnosed with DTC between January 1985 and January 2016 were analyzed. Only patients with proven structural persistent/recurrent disease were selected for comparisons. RESULTS This study consisted of 1691 patients (female, 1367) with DTC. In Kaplan-Meier analysis, disease-free survival (DFS) was markedly longer in females only in the ATA low-risk category (P = .045). Nevertheless, a markedly longer DFS was observed in patients aged <45 years in the ATA low- and intermediate-risk categories (P = .004 and P = .009, respectively), whereas in patients aged <55 years, DFS was markedly longer only in the ATA low-risk category (P < .001). In the Cox proportional hazards model, ages of ≥45 and ≥55 years at diagnosis and the ATA risk stratification system were all independent predictors of persistent/recurrent disease. CONCLUSION Applying the age cutoff of 45 years in the ATA intermediate- and low-risk categories may identify patients at a higher risk of persistence/recurrence and may improve the performance of the ATA risk stratification system, whereas sex may improve the performance of only the ATA low-risk category.
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7
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Dellal FD, Aydin C, Tam AA, Faki S, Alkan A, Polat SB, Dirikoc A, Topaloglu O, Ersoy R, Cakir B. The value of serum thyroglobulin alteration after ultrasonography-guided fine-needle biopsy of suspicious cervical lymph nodes in the diagnosis of metastasis in patients with differentiated thyroid cancer. Int J Clin Pract 2021; 75:e14218. [PMID: 33866655 DOI: 10.1111/ijcp.14218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/18/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND It is known that serum thyroglobulin (TG) can increase after fine-needle biopsy of thyroid nodules. We aimed to determine whether TG is increased after ultrasonography (US)-guided fine needle capillary biopsy (FNC) of suspicious cervical lymph nodes (LNs) in thyroidectomised patients and investigate the possible association between change in TG and cytology results. MATERIAL AND METHODS Data of 188 patients who underwent FNC of suspicious cervical LNs were retrospectively evaluated. Demographical, laboratory and ultrasonography features of LNs were noted. TG levels before FNC (TGb-FNC ), after FNC (TGa-FNC ), TGa-FNC /TGb-FNC ratio and the number of patients with increased TG were determined. Patients were grouped as benign, nondiagnostic, suspicious for malignancy and malignant according to the cytological results. RESULTS TGa-FNC , TGb-FNC /TGa-FNC and rate of patients with increased TG were significantly higher in malignant cytology group than other groups (P < .001). The optimal cut-off level of TG increase that was predictive for malignancy was 7.6% with a sensitivity of 73.7% and specificity of 85.2%. TG increase was not associated with age, sex, Thyroid-stimulating hormone (TSH) level, anti-TG positivity and US features of LNs while significantly lower in patients who received radioactive iodine (RAI) treatment. Among 31 patients with positive anti-TG, TGb-FNC /TGa-FNC , and rate of patients with increased TG were higher in malignant compared to benign and nondiagnostic cytology groups. CONCLUSIONS Serum TG increment and rate of patients with increased TG after FNC of suspicious cervical LNs were higher in patients with malignant cytology than with all other cytology results both in all study group and in sub-group of anti-TG positive patients. Increase in TG after FNC might be an additional tool for determining LN metastasis.
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Affiliation(s)
- Fatma Dilek Dellal
- Department of Endocrinology and Metabolism Disease, Ankara City Hospital, Ankara, Turkey
| | - Cevdet Aydin
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Abbas Ali Tam
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Sevgul Faki
- Department of Endocrinology and Metabolism Disease, Ankara City Hospital, Ankara, Turkey
| | - Afra Alkan
- Department of Biostatistics, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Sefika Burcak Polat
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Ahmet Dirikoc
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism Disease, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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The Presence of Hypoechoic Micronodules in Patients with Hashimoto's Thyroiditis Increases the Risk of an Alarming Cytological Outcome. J Clin Med 2021; 10:jcm10040638. [PMID: 33562377 PMCID: PMC7915457 DOI: 10.3390/jcm10040638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of the study was to identify a possible relation between various ultrasonographic (US) appearances of Hashimoto's thyroiditis (HT) and the risk of obtaining an alarming cytology of coexisting nodules. The study included 557 patients with HT, who had been referred for fine needle aspiration biopsy (FNA). We divided US patterns of HT (UP-HT) into eight groups: (a) Hypoechoic (compared to submandibular glands), homogeneous/fine echotexture; (b) hypoechoic, heterogeneous/coarse echotexture; (c) marked hypoechoic (darker than strap muscles), heterogeneous/coarse echotexture; (d) heterogeneous echotexture with hyperechoic, fibrous septa; (e) multiple, discrete marked hypoechoic areas (sized as 1 to 6 mm); (f) normoechoic pseudo-nodular areas; (g) echostructure similar to connective tissue; (h) thyroid parenchyma with no signs of HT. Indications for a surgical treatment resulting from the FNA outcome (categories IV-VI of Bethesda System for Reporting Thyroid Cytopathology) were identified only in patients with variants b, c, and e of UP-HT, but merely the "multiple, discrete marked hypoechoic areas" variant significantly increased the odds of obtaining such cytology (OR:5.7). The presence of the "normoechoic pseudo-nodular areas" variant significantly increased the odds for the benign cytology (OR:1.7). There are significant differences in the frequency of obtaining an alarming cytology in relation to the UP-HT variant.
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Asimakopoulos P, Shaha AR, Nixon IJ, Shah JP, Randolph GW, Angelos P, Zafereo ME, Kowalski LP, Hartl DM, Olsen KD, Rodrigo JP, Vander Poorten V, Mäkitie AA, Sanabria A, Suárez C, Quer M, Civantos FJ, Robbins KT, Guntinas-Lichius O, Hamoir M, Rinaldo A, Ferlito A. Management of the Neck in Well-Differentiated Thyroid Cancer. Curr Oncol Rep 2020; 23:1. [PMID: 33190176 DOI: 10.1007/s11912-020-00997-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. RECENT FINDINGS Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.
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Affiliation(s)
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Jatin P Shah
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Mark E Zafereo
- Head and Neck Endocrine Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain
| | - Miquel Quer
- Department of Otolaryngology-Head and Neck Surgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Surgery Department, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL, USA
| | | | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Liu Y, Li L, Liu Z, Yuan Q, Lu X. Plasma miR-323 as a Biomarker for Screening Papillary Thyroid Cancer From Healthy Controls. Front Med (Lausanne) 2020; 7:122. [PMID: 32478079 PMCID: PMC7242560 DOI: 10.3389/fmed.2020.00122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
The present study aims to evaluate whether plasma miR-323 serves as a potential biomarker to screen patients with papillary thyroid cancer (PTC) from healthy controls. Real-time PCR was performed to evaluate miR-323 expression in healthy controls and benign thyroid nodule (BTN) and PTC patients. Receiver operating characteristic (ROC) curve analysis was used to evaluate whether plasma miR-323 could be used to screen PTC patients from BTN patients and healthy controls. Plasma miR-323 was significantly increased in PTC patients compared with that in BNT patients and healthy controls. Moreover, miR-323 in the thyroid tissue was significantly increased in PTC patients when compared to BNT patients. We further showed that plasma and tissue miR-323 levels were significantly increased in PTC patients with metastasis compared to those without metastasis. Plasma miR-323 was significantly increased in PTC patients with BRAF V600E mutation when compared to those with wild-type BRAF. Furthermore, plasma miR-323 was significantly increased in PTC patients with higher Tg-FNAB. ROC analysis showed that plasma miR-323 could distinguish PTC patients from BNT patients and healthy controls. The present study demonstrated that plasma miR-323 might be an effective noninvasive indicator for PTC progression and serve as a biomarker for the diagnosis of PTC.
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Affiliation(s)
- Yang Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Li
- Department of Dermatology, Henan Children's Hospital, Zhengzhou, China
| | - Zheng Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingling Yuan
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiubo Lu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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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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12
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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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Gao L, Wang J, Jiang Y, Gao Q, Wang Y, Xi X, Zhang B. The Number of Central Lymph Nodes on Preoperative Ultrasound Predicts Central Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Prospective Cohort Study. Int J Endocrinol 2020; 2020:2698659. [PMID: 32351558 PMCID: PMC7178523 DOI: 10.1155/2020/2698659] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/20/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022] Open
Abstract
To evaluate the effectiveness of the number of central compartment lymph nodes (CLNs) on ultrasound (US) in predicting CLN metastasis (CLNM). We prospectively studied 309 papillary thyroid cancer (PTC) patients who underwent thyroidectomy with CLN dissection at our center from May 2017 to July 2017. The number and features of CLNs were evaluated preoperatively via US. All US examinations were performed using a Philips iU 22 or a GE Logiq 9 machine. Correlations between CLNs observed via preoperative US and amount of CLNM were evaluated. We found that ≥2 CLNs on the preoperative US was associated with CLNM (P < 0.01). For this feature, the sensitivity, specificity, and area under the curve (AUC) were 54.3%, 66.1%, and 0.61, respectively. The presence of both suspected metastasis and ≥2 CLNs on US had a specificity of 86.5%. In addition, ≥3 CLNs on preoperative US was associated with large-volume CLNM (>5 metastatic CLNs) (P < 0.01). For this feature, the sensitivity, specificity and AUC were 54.8%, 74.5% and 0.65, respectively. The presence of both suspected metastasis and ≥3 CLNs on US had a specificity of 84.9%. The presence of suspected metastasis and/or ≥3 CLNs had a sensitivity of 80.6%. Our results suggest that ≥2 and ≥ 3 CLNs on preoperative US may serve as ancillary preoperative markers for predicting CLNM.
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Affiliation(s)
- Luying Gao
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Juanjuan Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Qiong Gao
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Ying Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Xuehua Xi
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
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Hong CM, Jeong JH, Son SH, Lee CH, Jeong SY, Lee SW, Lee J, Ahn BC. Serum thyroglobulin elevation after needle aspiration of the lymph nodes: the predictive value for detecting metastasis in papillary thyroid cancer patients - a pilot study. Medicine (Baltimore) 2019; 98:e16461. [PMID: 31374007 PMCID: PMC6708928 DOI: 10.1097/md.0000000000016461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Ultrasonography (USG)-guided fine needle aspiration (FNA) is widely used for diagnosis of lymph node (LN) metastasis in papillary thyroid cancer (PTC). However, FNA cytology sometimes shows inconclusive results. Recently, the measurement of thyroglobulin (Tg) in FNA washout fluid (aspirate-Tg) has been widely adopted, but there are some difficulties in the preparation of the sample and standardization of the procedure. Here, we examined serum Tg after FNA as a new predictive marker for LN metastasis of PTC. We performed USG-guided FNA cytology and examined aspirate-Tg in PTC patients showing suspicious metastatic LNs during follow-up. We measured baseline serum thyroid stimulating hormone (TSH), Tg, and Tg antibody levels before FNA, and serum Tg level within an hour after FNA. We defined aspirate-Tg level above 0.9 ng/mL as positive, and a 30% increase in serum Tg level after FNA compared to the baseline as elevation of serum Tg. Twenty-two patients were included in our study. Nine patients (40.9%) showed elevation of Tg level after FNA, and the mean value of Tg elevation was 24.8 ± 48.0 ng/mL. Among these 9 patients, 8 were diagnosed with PTC and 1 patient showed cellular atypia on cytopathology. All these patients showed positive aspirate-Tg. Thirteen patients (59.1%) did not show elevation of Tg level after FNA. Among these patients, 2 had PTC, 2 had cellular atypia, and 9 yielded negative results for malignancy on cytopathology. Elevation of serum Tg level after FNA might have a diagnostic role for predicting LN metastasis of PTC.
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Affiliation(s)
- Chae Moon Hong
- Departments of Nuclear Medicine, Kyungpook National University Hospital
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Ju Hye Jeong
- Departments of Nuclear Medicine, Kyungpook National University Hospital
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Hyun Son
- Departments of Nuclear Medicine, Kyungpook National University Hospital
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang-Hee Lee
- Departments of Nuclear Medicine, Kyungpook National University Hospital
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin Young Jeong
- Departments of Nuclear Medicine, Kyungpook National University Hospital
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sang-Woo Lee
- Departments of Nuclear Medicine, Kyungpook National University Hospital
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaetae Lee
- Departments of Nuclear Medicine, Kyungpook National University Hospital
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Byeong-Cheol Ahn
- Departments of Nuclear Medicine, Kyungpook National University Hospital
- Departments of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Kuo JH, McManus C, Graves CE, Madani A, Khokhar MT, Huang B, Lee JA. In brief. Curr Probl Surg 2019. [DOI: 10.1067/j.cpsurg.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wang D, Guo C, Kong T, Mi G, Li J, Sun Y. Serum miR-22 may be a biomarker for papillary thyroid cancer. Oncol Lett 2019; 17:3355-3361. [PMID: 30867770 PMCID: PMC6396224 DOI: 10.3892/ol.2019.10011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/23/2018] [Indexed: 12/31/2022] Open
Abstract
The present study aimed to examine whether serum microRNA (miR)-22 may be considered a potential biomarker to differentiate patients with papillary thyroid cancer (PTC) from healthy controls. Reverse transcription-quantitative polymerase chain reaction demonstrated that serum miR-22 expression was significantly enhanced in patients with PTC compared with in patients with benign thyroid nodules (BTN) and healthy controls. The expression levels of miR-22 were also increased in the thyroid tissue of patients with PTC compared with in patients with BTN. In addition, increased miR-22 in the serum of patients with PTC was positively associated with metastasis. Furthermore, miR-22 serum levels were increased in patients with PTC and the B-Raf proto-oncogene, serine/threonine kinase V600E mutation. Meanwhile, compared with patients with PTC and ≤1 ng/ml thyroglobulin (Tg)-fine needle aspiration biopsy (FNAB), serum miR-22 was significantly enhanced in patients with PTC and 1-10 ng/ml Tg-FNAB and >10 ng/ml Tg-FNAB. A receiver operating characteristic analysis demonstrated that serum miR-22 distinguished patients with PTC from patients with BTN and healthy controls. In conclusion, to the best of our knowledge, the present study was the first to demonstrate that upregulation of serum miR-22 may be used as a potential biomarker to distinguish patients with PTC from healthy controls.
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Affiliation(s)
- Deping Wang
- Department of Endocrinology and Metabolism, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang 157011, P.R. China
| | - Changxiu Guo
- Department of Endocrinology and Metabolism, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang 157011, P.R. China
| | - Tingting Kong
- Department of Otolaryngology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang 157011, P.R. China
| | - Guangxi Mi
- Department of Otolaryngology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang 157011, P.R. China
| | - Jiantao Li
- Department of Otolaryngology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang 157011, P.R. China
| | - Yuhan Sun
- Department of Otolaryngology, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang 157011, P.R. China
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Kuo JH, McManus C, Graves CE, Madani A, Khokhar MT, Huang B, Lee JA. Updates in the management of thyroid nodules. Curr Probl Surg 2018; 56:103-127. [PMID: 30798796 DOI: 10.1067/j.cpsurg.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Jennifer H Kuo
- Division of Endocrine Surgery, Columbia University, New York, NY.
| | | | - Claire E Graves
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - Amin Madani
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - Mamoona T Khokhar
- Division of Endocrine Surgery, Banner University Medical Center, Phoenix, AZ
| | - Bernice Huang
- Division of Endocrine Surgery, Columbia University, New York, NY
| | - James A Lee
- Division of Endocrine Surgery, Columbia University, New York, NY
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19
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Periakaruppan G, Seshadri KG, Vignesh Krishna GM, Mandava R, Sai VPM, Rajendiran S. Correlation between Ultrasound-based TIRADS and Bethesda System for Reporting Thyroid-cytopathology: 2-year Experience at a Tertiary Care Center in India. Indian J Endocrinol Metab 2018; 22:651-655. [PMID: 30294576 PMCID: PMC6166562 DOI: 10.4103/ijem.ijem_27_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In recent times, high-resolution ultrasound thyroid imaging has paved the way for significant transformation in clinical approach to thyroid nodule. There are several risk stratification systems in thyroid imaging, developed with an aim, not only to reduce the inter-observer variability but also to establish effective communication system. Thyroid image reporting and data system (TIRADS) classification system, which is similar to breast imaging reporting and data system for breast lesion, is the most useful of all. To our knowledge, there is just a handful published research articles available based on Indian population in this regard. In this article, we study the thyroid nodules using high-resolution ultrasound in Indian population and we try to correlate the TIRADS and Bethesda system for reporting thyroid cytopathology. MATERIALS AND METHODS This prospective study includes 184 patients studied over a period of 2 years (April 2015-April 2017). Patients having thyroid nodule in B-mode ultrasound and are scheduled to get a fine-needle aspiration cytology (FNAC) done. Bethesda classification of these nodules is tabulated in follow-up period simultaneously. By comparing these data, efficacy of TIRADS in differentiating benign from malignant nodules are assessed finally using accuracy, positive predictive value (PPV), cross-tabulation, and Chi-square tests. RESULTS Out of the 117 TIRADS 2 nodules, none turned out to be Bethesda IV or higher, which means none of these nodules turned out to be malignant. The risk of malignancy for TIRADS 2, TIRADS 3, TIRADS 4, and TIRADS 5 was 0, 2.2, 38.5, and 77.8%, respectively. The risk of malignancy percentage in our study is similar to those values obtained in other prominent studies. CONCLUSION The probability of a particular nodule being malignant can be effectively inferred from the ultrasound-based TIRADS system with a certain level of confidence. Considering our results and other literature reviews, it be can be safely assumed that FNAC can be at least deferred in patients having TIRADS 2 nodules, which contribute to majority of newly detected cases. In our experience, there is a remarkable correlation exists between TIRADS ultrasound classification and Bethesda cytology, especially for benign nodules.
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Affiliation(s)
| | - Krishna G. Seshadri
- Department of Endocrinology, Diabetes and Metabolism, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - G. M Vignesh Krishna
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Rupesh Mandava
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Venkata P. M Sai
- Department of Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - S Rajendiran
- Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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20
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Woods SJ, Palm C, Sheley M, Feldman EC, Pollard RE. Ultrasonography does not consistently detect parathyroid glands in healthy cats. Vet Radiol Ultrasound 2018; 59:737-743. [PMID: 29998595 DOI: 10.1111/vru.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/16/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022] Open
Abstract
Ultrasound is used to evaluate the parathyroid glands of several species but there are limited reports of its use in cats. With this prospective anatomic study, we hypothesized that ultrasound could identify two parathyroid glands as hypoechoic nodules associated with each thyroid lobe and that a normal size range could be established. Six cat cadavers were imaged with ultrasound and histopathology of the thyroid and parathyroid tissue was performed for comparison. In addition, clinically healthy adult cats were prospectively recruited and placed in Group 1 (2-6 years; n = 11) or Group 2 (7-13 years; n = 9). Ultrasound of the cervical region was performed using a 7-15 MHz linear transducer. Number, size, and location of all hypoechoic nodules within or immediately adjacent to the thyroid lobes were documented. Ultrasound identified between 0-6 hypoechoic nodules per thyroid lobe in cat cadavers and between 0-3 hypoechoic nodules per thyroid lobe in clinically healthy cats, which does not correlate with the normal anatomy. In conclusion, parathyroid glands were frequently not ultrasonographically observed or were not distinguishable from thyroid tissue and this problem was worse in older cats because of the prevalence of nodular thyroid lesions, which primarily included foci of adenomatous hyperplasia.
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Affiliation(s)
- Sarah J Woods
- School of Veterinary Medicine, Veterinary Medical Teaching Hospital, University of California, Davis, CA 95616
| | - Carrie Palm
- Department of Medicine and Epidemiology, University of California, Davis, CA 95616
| | - Matt Sheley
- School of Veterinary Medicine, Veterinary Medical Teaching Hospital, University of California, Davis, CA 95616
| | - Edward C Feldman
- Department of Medicine and Epidemiology, University of California, Davis, CA 95616
| | - Rachel E Pollard
- Department of Surgical and Radiological Sciences, University of California, Davis, CA 95616
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Jiang H, Wu C, Chiang F, Chiou H, Chen I, Hsiao P. Reliable sonographic features for nodal thyroglobulin to diagnose recurrent lymph node metastasis from papillary thyroid carcinoma. Clin Otolaryngol 2018; 43:1065-1072. [DOI: 10.1111/coa.13103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- H.‐J. Jiang
- Division of Endocrinology and Metabolism Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Internal Medicine Kaohsiung Municipal Ta‐Tung Hospital Kaohsiung Taiwan
| | - C.‐W. Wu
- Department of Otolaryngology‐Head and Neck Surgery Kaohsiung Medical University Kaohsiung Taiwan
- School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - F.‐Y. Chiang
- Department of Otolaryngology‐Head and Neck Surgery Kaohsiung Medical University Kaohsiung Taiwan
- School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - H.‐Y.C. Chiou
- Division of Endocrinology and Metabolism Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - I.‐J. Chen
- Department of Nuclear Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - P.‐J. 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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22
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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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Sonographic Features of Cervical Lymph Nodes in Patients With Hashimoto Thyroiditis and the Impacts From the Levothyroxine With Prednisone Therapy. Ultrasound Q 2017; 34:67-70. [PMID: 29112639 DOI: 10.1097/ruq.0000000000000324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study aimed to evaluate the ultrasonographic pattern of cervical lymph nodes (CLNs) and whether levothyroxine with prednisone therapy is effective for lymphadenopathy in patients with Hashimoto thyroiditis (HT). METHODS This retrospective study was looking at patients with confirmed diagnosis of HT who underwent comprehensive neck ultrasound examination. We reviewed sonographic findings in 127 patients with HT, 234 euthyroid patients with goiter, and 122 healthy subjects. In addition, 30 untreated HT patients with cervical lymphadenopathy were recruited for the levothyroxine with prednisone therapy. We rescanned the patients 9 months after treatment with levothyroxine and prednisone. RESULTS Patients with HT had a higher rate of CLN detection on ultrasound than euthyroid patients with goiter and healthy subjects at cervical levels III, IV, and VI (P < 0.01). In addition, patients with HT had a higher rate of detection of CLNs with abnormal sonographic features than the other 2 groups, most notably at cervical levels III, IV, and VI (P < 0.01). After the treatment, the mean thyroid volume, thyroid nodule volume, CLN volume, symptom score, and cosmetic grade of 30 HT patients were remarkably decreased (P < 0.01 or P < 0.001). CONCLUSIONS Hashimoto thyroiditis seems to be associated with an increased rate of detection of CLNs with abnormal sonographic features, particularly at cervical levels III, IV, and VI. Therapy with levothyroxine with prednisone is effective for cervical lymphadenopathy in patients with HT.
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Borhani AA, Monaco SE. Chapter 7 Image-Guided Fine-Needle Aspiration and Core Needle Biopsy of Neck Lymph Nodes: Techniques, Pearls, and Pitfalls. Semin Ultrasound CT MR 2017; 38:531-541. [DOI: 10.1053/j.sult.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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Rossi M, Lupo S, Rossi R, Franceschetti P, Trasforini G, Bruni S, Tagliati F, Buratto M, Lanza G, Damiani L, Degli Uberti E, Zatelli MC. Proposal for a novel management of indeterminate thyroid nodules on the basis of cytopathological subclasses. Endocrine 2017; 57:98-107. [PMID: 27623969 DOI: 10.1007/s12020-016-1105-4] [Citation(s) in RCA: 10] [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] [Received: 05/26/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023]
Abstract
Indeterminate thyroid nodules include heterogeneous lesions that could benefit from a differential management. Our aim is to better define the management of the Bethesda System for Reporting Thyroid Cytopathology class III and IV nodules, by identifying cytological subcategories among Bethesda System for Reporting Thyroid Cytopathology class III associated with different clinical risk, by means of ultrasound, repeated FNAB, and BRAFV600E molecular analysis. We also evaluated the outcome of nodules not operated, over a 5-year follow-up. Out of 460 nodules (269 Bethesda System for Reporting Thyroid Cytopathology class III and 191 Bethesda System for Reporting Thyroid Cytopathology class IV), 344 were operated on surgical group and 116 followed-up conservatively (follow-up group). Bethesda System for Reporting Thyroid Cytopathology class III was divided into four subcategories on the basis of cytomorphological features (III-1, III-2, III-3, III-4). Clinical risk was defined on the basis of histological, cytological, and ultrasound data. Malignancy was higher in Bethesda System for Reporting Thyroid Cytopathology class III vs. Bethesda System for Reporting Thyroid Cytopathology class IV (34.4 vs. 26.2 %; p < 0.01). Papillary thyroid carcinoma was the most frequent cancer in each Bethesda System for Reporting Thyroid Cytopathology class (35 %). BRAFV600E diagnostic accuracy was 87 %. Repeated FNAB reclassified as benign nearly 40 % of nodules, selecting patients where surgery could be spared. Significant nodule growth occurred in 13.7 % of nodules, belonging mostly to Bethesda System for Reporting Thyroid Cytopathology class III-2 and Bethesda System for Reporting Thyroid Cytopathology class IV. Overall clinical risk was higher in Bethesda System for Reporting Thyroid Cytopathology III-1, III-4, and IV classes. We propose a differential management of Bethesda System for Reporting Thyroid Cytopathology III and IV classes and related subcategories: surgery may be indicated in Bethesda System for Reporting Thyroid Cytopathology class III-1, III-4, and IV; a conservative follow-up avoiding repeated FNAB may be appropriated in class III-3, while repeated FNAB may be useful in class III-2.
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Affiliation(s)
- Martina Rossi
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Sabrina Lupo
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Roberta Rossi
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Paola Franceschetti
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Giorgio Trasforini
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Stefania Bruni
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Federico Tagliati
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Mattia Buratto
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Giovanni Lanza
- Section of Pathology and Biomolecular Diagnostics, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Luca Damiani
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
| | - Ettore Degli Uberti
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Via Ariosto 35, Ferrara, 44121, Italy.
- Endocrinology Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy.
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Abstract
Parathyroid cysts (PCs) account for less than 1% of all parathyroid lesions and are most commonly located along thyroid lobes, rarely at ectopic sites. PCs are important because they can pose a differential diagnostic challenge against other cystic formations of the neck. PCs can be functional (elevated serum parathyroid hormone level) and nonfunctional. Four cases of nonfunctional PCs are presented. All four female patients underwent physical examination and ultrasonography of the neck with ultrasound-guided fine-needle aspiration biopsy (UG-FNA). The material thus obtained was stained by the standard May-Grünwald-Giemsa method. Parathyroid hormone level was determined in aspirate and serum, along with serum levels of total calcium, inorganic phosphates. In two asymptomatic patients, remission occurred after initial aspiration biopsy; one patient had compression syndrome with vocal cord paresis that required surgical treatment; and one patient had cyst recurrence that was surgically removed. Cystic neck masses can pose a major differential diagnostic problem considering different approach, treatment method, and preoperative and postoperative follow up. Surgical treatment is necessary in case of functional and large nonfunctional PCs (due to compression syndrome), whereas individualized therapeutic approach is used in case of small nonfunctional PCs. Ultrasonography with UG-FNA, cytologic analysis of the material obtained, and determination of parathyroid hormone level in aspirate and serum are crucial for making an accurate diagnosis.
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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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Kannan S, Chauhan S, Naveen, Latha BS, Raju N, Chandrasekhar NH, Kekatpure V, Kuriakose MA, Manjunath P. Estimation of thyroglobulin in lymph node aspirates: Pilot experience from a tertiary referral cancer center. Indian J Endocrinol Metab 2016; 20:359-63. [PMID: 27186554 PMCID: PMC4855965 DOI: 10.4103/2230-8210.179987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Assessment of cervical lymph node involvement in patients with thyroid cancer either during preoperative surgical mapping or detection of recurrences during follow-up is a crucial step in the management of differentiated thyroid cancers (DTCs). In most patients, fine needle aspiration cytology (FNAC) confirms the presence of metastasis in lymph node. However, in cases of paucicellular lymph node aspirate or discordant sonogram and cytology results, thyroglobulin (Tg) measurement in the lymph node aspirate (FNA-Tg) is useful and a value >1 ng/ml is considered consistent with metastatic disease. Context: The addition of FNAC to the US improves the specificity, but 5–10% are nondiagnostic and 6–8% rate of false-negative results. Several studies have reported that the detection of Tg in FNA-needle washes improves the evaluation of suspicious lymph nodes in patients with DTC.Data from Indian centers on FNA-Tg are limited. Aims: We piloted the utility of FNA-Tg in patients with sonographically suspicious cervical lymph node enlargement in the setting of suspicious thyroid nodule or in the follow-up of thyroid cancer. Settings and Design: Prospective data collection. Results: We measured Tg in 13 lymph node aspirates (12 patients, 10 females) among whom 4 patients had a total thyroidectomy and 1 had a hemithyroidectomy. Eight of the 13 lymph node aspirates had FNA-Tg values >150 ng/ml, all of them had unequivocal malignant cytology and four among them had proven metastatic DTC on surgical pathology. The median FNA-Tg of the patients with malignant cytology was 7550 ng/ml with a range of 162–30,000 ng/ml. Among the remaining 5 lymph node aspirate, 2 lymph nodes showed cytological features suggestive of reactive lymphadenitis (FNA-Tg <0.2 ng/ml) and were not operated, 1 had a high-grade malignancy consistent with anaplastic thyroid cancer (FNA-Tg <0.2 ng/ml), and 2 had nondiagnostic cytology (one had non-caseating granuloma on surgical pathology [FNA-Tg 1.3 ng/ml] and in the other patient [FNA-Tg <0.2 ng/ml] surgical intervention was deferred). Conclusions: FNA-Tg was concordant with positive cytology in all patients with DTC and may serve as a useful tool in patients with negative and nondiagnostic cytology to guide surgical management.
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Affiliation(s)
- Subramanian Kannan
- Department of Endocrinology, Diabetes and Bariatric Medicine, Narayana Health City, Bangaluru, Karnataka, India
| | - Subhra Chauhan
- Head and Neck Surgical Oncology and Reconstructive Surgery, Narayana Health City, Bangaluru, Karnataka, India
| | - Naveen
- Head and Neck Surgical Oncology and Reconstructive Surgery, Narayana Health City, Bangaluru, Karnataka, India
| | - B S Latha
- Department of Laboratory Medicine, Narayana Health City, Bangaluru, Karnataka, India
| | - Nalini Raju
- Department of Pathology, Narayana Health City, Bangaluru, Karnataka, India
| | - Naveen Hedne Chandrasekhar
- Head and Neck Surgical Oncology and Reconstructive Surgery, Narayana Health City, Bangaluru, Karnataka, India
| | - Vikram Kekatpure
- Head and Neck Surgical Oncology and Reconstructive Surgery, Narayana Health City, Bangaluru, Karnataka, India
| | - Moni Abraham Kuriakose
- Head and Neck Surgical Oncology and Reconstructive Surgery, Narayana Health City, Bangaluru, Karnataka, India
| | - P Manjunath
- Department of Radiology, Narayana Health City, Bangaluru, Karnataka, India
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8617] [Impact Index Per Article: 1077.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Khokhar MT, Day KM, Sangal RB, Ahmedli NN, Pisharodi LR, Beland MD, Monchik JM. Preoperative High-Resolution Ultrasound for the Assessment of Malignant Central Compartment Lymph Nodes in Papillary Thyroid Cancer. Thyroid 2015; 25:1351-4. [PMID: 26431908 DOI: 10.1089/thy.2015.0176] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The identification and removal of malignant central compartment lymph nodes (MCLN) is important to minimize the risk of persistent or recurrent local disease in patients with papillary thyroid cancer (PTC). While the diagnostic accuracy of preoperative ultrasound for the assessment of lateral compartment node metastases is well recognized, its role in the identification of central compartment node metastases in patients with PTC is less established. This study delineates the utility of high-resolution ultrasound (HUS) for the assessment of MCLN in patients with PTC. METHODS A retrospective chart review was performed of 227 consecutive patients who underwent total thyroidectomy for biopsy-proven PTC by a single endocrine surgeon in an academic tertiary care center between 2004 and 2014. Preoperative sonographic results were compared to postoperative pathology reports to determine the accuracy of HUS for the assessment of MCLN. Statistical analysis also included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS HUS identified abnormal central compartment nodes in 51 (22.5%) patients. All 227 patients underwent a careful central compartment node exploration. One hundred and four (45.8%) patients had MCLN identified by surgery, of whom 65 (62.5%) had a negative preoperative central compartment HUS. The sensitivity and specificity of preoperative HUS for the assessment of MCLN were 0.38 and 0.90, respectively. The PPV and NPV were 0.76 and 0.63, with an accuracy of 0.66. CONCLUSION Preoperative HUS is quite specific for the identification of MCLN in patients with PTC. The present findings emphasize, however, that a negative HUS does not obviate the need for careful exploration of the central compartment to minimize the risk of persistent or recurrent local disease.
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Affiliation(s)
- Mamoona T Khokhar
- 1 Department of Surgery, Brown University , Providence, Rhode Island
- 2 Division of Endocrine Surgery, Rhode Island Hospital , Providence, Rhode Island
| | - Kristopher M Day
- 1 Department of Surgery, Brown University , Providence, Rhode Island
- 2 Division of Endocrine Surgery, Rhode Island Hospital , Providence, Rhode Island
| | - Rohit B Sangal
- 3 Warren Alpert School of Medicine, Brown University , Providence, Rhode Island
| | - Nigar N Ahmedli
- 3 Warren Alpert School of Medicine, Brown University , Providence, Rhode Island
| | - Latha R Pisharodi
- 4 Department of Pathology, Brown University , Providence, Rhode Island
| | - Michael D Beland
- 5 Department of Radiology, Brown University , Providence, Rhode Island
| | - Jack M Monchik
- 1 Department of Surgery, Brown University , Providence, Rhode Island
- 2 Division of Endocrine Surgery, Rhode Island Hospital , Providence, Rhode Island
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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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Kim SM, Kim HK, Kim KJ, Chang HJ, Kim BW, Lee YS, Chang HS, Park CS. Thyroidectomy without lateral neck dissection for papillary thyroid carcinoma with lateral neck lymph node metastases and negative intraoperative frozen section. Head Neck 2015; 38:285-9. [PMID: 25327877 DOI: 10.1002/hed.23893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the outcomes of patients with papillary thyroid cancer (PTC) with lateral neck metastasis according to their permanent pathology report but negative frozen section findings who did not undergo lateral neck dissection. METHODS Between September 2009 and December 2011, 575 patients at Gangnam Severance Hospital (Seoul, Korea) underwent frozen section analysis for a suspicious lateral neck lymph node. In 16 patients, the intraoperative findings were negative, but lateral neck metastasis was diagnosed on the basis of permanent pathology findings. The outcomes of these patients who underwent thyroidectomy but not lateral neck dissection were retrospectively investigated. RESULTS One patient underwent a subsequent lateral neck dissection. After a mean (SD) follow-up period of 42.1 (8.5) months, none of the patients had distant metastasis. CONCLUSION Total thyroidectomy with subsequent lateral neck dissection is not necessary in patients with PTC who are diagnosed with lateral neck metastasis according to their permanent pathology report but have negative intraoperative frozen section findings.
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Affiliation(s)
- Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeung Kyoo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kuk-Jin Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Jin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bup-Woo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Jakowski JD, DiNardo LJ. Advances in head and neck fine-needle aspiration and ultrasound technique for the pathologist. Semin Diagn Pathol 2015; 32:284-95. [DOI: 10.1053/j.semdp.2014.12.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pak K, Suh S, Hong H, Cheon GJ, Hahn SK, Kang KW, Kim EE, Lee DS, Chung JK. Diagnostic values of thyroglobulin measurement in fine-needle aspiration of lymph nodes in patients with thyroid cancer. Endocrine 2015; 49:70-7. [PMID: 25185721 DOI: 10.1007/s12020-014-0410-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/27/2014] [Indexed: 11/24/2022]
Abstract
We aimed to evaluate the diagnostic performance of measuring the concentration of thyroglobulin (Tg) in the washout fluid of the needle aspiration (FNA-Tg). We performed a systematic search of MEDLINE (inception to October 2013) and EMBASE (inception to October 2013) for English publications using keywords "thyroid", "aspiration", "washout", and "thyroglobulin". All searches were limited to human studies. We included studies of FNA-Tg measurement in the washout fluid rinsed with 1 ml of normal saline. Eight studies including 843 lymph nodes (LNs) were eligible for this study. The pooled sensitivity and specificity of preoperative studies are 0.89 [95 % CI 0.82-0.95], 0.60 [0.49-0.70], and those of postoperative studies are 1.0 [0.83-1.0], 1.0 [0.92-1.0]. To determine best cutoffs from each preoperative and postoperative study, the distance between the point (0, 1) and each observed cutoff values (1-specificity, sensitivity) was calculated, and the distance is minimal when the cutoff value of 32.04 for preoperative studies and of 0.9 for postoperative one are selected. FNA-Tg can be used for both preoperative and postoperative evaluation of LN metastasis. Although the cutoff values for the FNA-Tg has not been standardized, preoperative values of 32.04 ng/ml and postoperative values of 0.9 ng/ml are recommended for identifying neck LN metastasis.
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Affiliation(s)
- Kyoungjune Pak
- Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea,
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Zhang HS, Wang RJ, Fu QF, Gao S, Sun BT, Sun H, Ma QJ. Diagnostic value of Thyroglobulin Measurement with Fine-needle Aspiration Biopsy for Lymph Node Metastases in Patients with a History of Differentiated Thyroid Cancer. Asian Pac J Cancer Prev 2015; 15:10905-9. [DOI: 10.7314/apjcp.2014.15.24.10905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Jun HH, Kim SM, Kim BW, Lee YS, Chang HS, Park CS. Overcoming the limitations of fine needle aspiration biopsy: detection of lateral neck node metastasis in papillary thyroid carcinoma. Yonsei Med J 2015; 56:182-8. [PMID: 25510763 PMCID: PMC4276754 DOI: 10.3349/ymj.2015.56.1.182] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer. MATERIALS AND METHODS FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared. RESULTS Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients, the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age <45 years (p=0.006), tumor size >1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003). CONCLUSION To reduce the false negative rate of FNAB, patient age (<45 years), tumor size (>1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.
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Affiliation(s)
- Hak Hoon Jun
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seok Mo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bup Woo Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Sang Lee
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Cheong Soo Park
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Grani G, Fumarola A. Thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis of diagnostic accuracy. J Clin Endocrinol Metab 2014; 99:1970-82. [PMID: 24617715 DOI: 10.1210/jc.2014-1098] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The thyroglobulin measurement in the needle washout after fine-needle aspiration (FNA) has been reported to increase the sensitivity of FNA in identifying lymph node (LN) metastases from differentiated thyroid cancer (DTC). OBJECTIVE The aim of the study was to estimate the diagnostic accuracy of this technique. DATA SOURCES To identify eligible studies, we searched electronic databases for original articles in English from 1975 through 2013. STUDY SELECTION Studies that enrolled participants with suspicious neck LNs during thyroid nodule workup or thyroid cancer follow-up were included. DATA EXTRACTION Working independently, authors used a standard form to extract data. For quality assessment, QUADAS2 guidelines were applied. DATA SYNTHESIS Including all the selected studies (24 studies, 2865 LNs) in the pooled analysis, overall sensitivity was 95.0% (95% confidence interval [CI], 93.7-96.0%), specificity was 94.5% (95% CI, 93.2-95.7%), and diagnostic odds ratio (DOR) was 338.91 (95% CI, 164.82-696.88) with significant heterogeneity (inconsistency [I(2)] = 65.7%; heterogeneity, P < .001). Stratifying different populations and including only patients with thyroid gland (410 LNs), pooled sensitivity was 86.2% (95% CI, 80.9-90.5%), specificity was 90.2% (85.1-94.0%), and DOR was 56.621 (22.535-142.26; I(2) = 37.3%; heterogeneity, P = .121). Including only patients after thyroidectomy (1007 LNs), pooled sensitivity was 96.9% (95% CI, 94.9-98.2%), specificity was 94.1% (91.7-96.0%), and DOR was 407.65 (198.67-836.46; I(2) = 0.0%; heterogeneity, P = .673). CONCLUSIONS Thyroglobulin measurement in washout from LN FNA has high accuracy in early detection of nodal metastases from DTC. The technique is simple, but a better standardization of criteria for patient selection, analytical methods, and cutoff levels is required.
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Affiliation(s)
- Giorgio Grani
- Department of Experimental Medicine, Unit of Endocrinology, "Sapienza" Università di Roma, 00161 Rome, Italy
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Familiar Casado C, Antón Bravo T, Moraga Guerrero I, Ramos Carrasco A, García García C, Villanueva Curto S. The value of thyroglobulin in washout of fine needle aspirate from 16 cervical lesions in patients with thyroid cancer. ACTA ACUST UNITED AC 2013; 60:495-503. [PMID: 24094451 DOI: 10.1016/j.endonu.2013.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Thyroglobulin in the needle washout (Tg-FNA) and cytology of fine needle aspiration (cyto-FNA) are recommended for diagnosis of metastatic lymphadenopathies and recurrence of differentiated thyroid cancer. The objective of this study was to assess the value of these procedures in 16 cervical masses from patients with thyroid cancer of the follicular epithelium (TC). PATIENTS AND METHODS The study included six patients with TC and cervical lymphadenopathies evaluated before initial thyroid surgery and 10 patients followed up after TC surgery with cervical lumps discovered. FNA was performed in all 16 masses. Results of cyto-FNA, Tg-FNA and of the combined tests were compared to the final diagnosis of each lesion. RESULTS Among 10 lesions proven to be malignant at surgery, cyto-FNA, Tg-FNA and the combination of both allowed for adequate diagnosis in 7, 9, and 10 cases respectively. Among 6 lesions considered to be benign, cyto-FNA was able to confirm diagnosis in 4, was non-diagnostic in one, and was falsely negative in the remaining case, while Tg-FNA was below the established cut-off value (to consider malignancy) in all cases. CONCLUSIONS In patients with TC and suspect cervical masses, Tg-FNA improved the diagnostic yield of cyto-FNA alone, thus warranting its routine recommendation when FNA is performed. However, universal standardization of the technique and definition of valid cut-off thyroglobulin values (depending on the immunoassay used) above which the lesion should be considered to be malignant are still pending.
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Chung J, Kim EK, Lim H, Son EJ, Yoon JH, Youk JH, Kim JA, Moon HJ, Kwak JY. Optimal indication of thyroglobulin measurement in fine-needle aspiration for detecting lateral metastatic lymph nodes in patients with papillary thyroid carcinoma. Head Neck 2013; 36:795-801. [PMID: 23616395 DOI: 10.1002/hed.23371] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/17/2013] [Accepted: 04/11/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate optimal indication of thyroglobulin (Tg) measurement in fine-needle aspiration (FNA) for detecting lateral metastatic lymph nodes in patients with papillary thyroid carcinoma (PTC). METHODS We performed a retrospective study of 241 lymph nodes of 220 patients who underwent ultrasound-guided FNA with Tg in FNA (FNA-Tg) washout fluid measurements for suspicious lymph nodes. RESULTS On multivariate analysis, hyperechogenicity, cystic change, presence of calcifications, and peripheral vascularity were independent factors predictive of lymph node metastasis. After adding FNA-Tg, sensitivity and accuracy were significantly increased when the lymph node had 1 or 2 suspicious ultrasound features. However, sensitivity and accuracy were not significantly increased when the lymph node had multiple suspicious ultrasound features. CONCLUSION Additional FNA-Tg can help diagnose a metastatic lymph node with 1 or 2 suspicious ultrasound features. However, additional FNA-Tg is not beneficial in lymph nodes with highly suspicious ultrasound features, in which FNA alone is sufficient for diagnosis of predictive of lymph node.
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Affiliation(s)
- Jin Chung
- Department of Radiology, Ewha Womans University, School of Medicine, Seoul, Korea
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Yuan Y, Kuai XP, Chen XS, Tao XF. Assessment of dynamic contrast-enhanced magnetic resonance imaging in the differentiation of malignant from benign orbital masses. Eur J Radiol 2013; 82:1506-11. [PMID: 23561057 DOI: 10.1016/j.ejrad.2013.03.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 03/04/2013] [Accepted: 03/10/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Dynamic contrast enhanced MR imaging (DCE-MRI) allows imaging of the physiology of the microcirculation. The purpose of this study was to determine the diagnostic efficacy of time intensity curve (TIC) and DCE parameters for characterization of orbital masses. METHODS Fifty-nine patients with untreated orbital lesions underwent DCE-MRI before surgery. For each lesion, peak height (PH), maximum enhancement ratio (ERmax), time of peak enhancement (Tpeak) and maximum rise slope (Slopemax) were plotted and calculated. Receiver operator characteristics (ROC) analysis was conducted to assess the appropriate cut-off value. RESULTS All 26 lesions that demonstrated persistent pattern (type-I) TICs were benign. Most of the masses with the washout pattern (type-III) TIC were malignant (10/14), including lymphoma (n=6) and melanoma (n=4). The Slopemax of benign lesions was statistically lower than malignant ones, while the ERmax and Tpeak values of benign lesions were significantly higher. No statistical difference was found in PH (P=0.121). The AUC for ERmax, Tpeak and Slopemax in differentiating benign orbital lesions from malignant ones were 0.683, 0.837 and 0.738, respectively. In the three DCE parameters, Slopemax cut-off value of 1.10 provided the highest sensitivity of 93.8%; however, the corresponding specificity was low (58.1%). The ERmax cut-off value of 1.37 and Tpeak cut-off value of 35.14 respectively offered the best diagnostic performances. CONCLUSION DCE-MRI, especially the qualitative TIC pattern and quantitative value of Slopemax, ERmax and Tpeak, could be a complementary investigation in distinguishing malignant orbital tumor from benign ones.
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Affiliation(s)
- Ying Yuan
- Department of Radiology, Shanghai Ninth People's Hospital, Affiliated to JiaoTong University School of Medicine, Shanghai 200011, China
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Moon JH, Kim YI, Lim JA, Choi HS, Cho SW, Kim KW, Park HJ, Paeng JC, Park YJ, Yi KH, Park DJ, Kim SE, Chung JK. Thyroglobulin in washout fluid from lymph node fine-needle aspiration biopsy in papillary thyroid cancer: large-scale validation of the cutoff value to determine malignancy and evaluation of discrepant results. J Clin Endocrinol Metab 2013; 98:1061-8. [PMID: 23393171 DOI: 10.1210/jc.2012-3291] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT There are still some controversies regarding the cutoff value and the influential factors of thyroglobulin (Tg) concentration in washout fluid from fine-needle aspiration (FNA) biopsy (FNA-Tg) on cervical lymph nodes (LNs) in patients with papillary thyroid cancer (PTC). OBJECTIVE Our aims were to validate the cutoff value of FNA-Tg in diagnosing malignant LNs on a large scale and to investigate the influential factors that could result in the discrepancy between the final diagnosis and FNA-Tg. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study based on hospital records with 528 cases of FNA-Tg measurement from 419 PTC patients. MAIN OUTCOME MEASURE The cutoff value of FNA-Tg was obtained from receiver operating characteristic analysis with final diagnosis. Binary logistic regression analysis was performed to investigate the influential factors. RESULTS In the final diagnosis, 190 LNs were malignant, and 338 LNs were benign. The median FNA-Tg was 521.2 (3676.8) ng/mL in malignant LNs, and 0.1 (0.2) ng/mL in benign LNs. The optimal cutoff value of FNA-Tg in distinguishing malignant LNs from benign LNs was 1.0 ng/mL (sensitivity, 93.2%; specificity, 95.9%) in all cases. Combining FNA-Tg and FNA cytology showed superior diagnostic power (sensitivity, 98.4%; specificity, 94.4%) when compared with diagnostic strategy using either FNA cytology or FNA-Tg alone. FNA-Tg, serum TSH, and serum Tg were higher in nonthyroidectomized patients than in thyroidectomized patients (P < .001, respectively). FNA-Tg was correlated with serum TSH and Tg levels (P < .001, respectively), and binary logistic regression analysis showed that serum TSH suppression and serum Tg presence independently affected the diagnosis made by FNA-Tg. CONCLUSIONS Our results validated 1.0 ng/mL of FNA-Tg as a cutoff value for diagnosing LN metastasis of PTC and suggested that serum TSH suppression and serum Tg presence should be considered in diagnosing LN malignancy with FNA-Tg in PTC patients.
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Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
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Long-term effectiveness of ultrasound-guided laser ablation of hyperfunctioning parathyroid adenomas: present and future perspectives. AJR Am J Roentgenol 2013; 199:1164-8. [PMID: 23096194 DOI: 10.2214/ajr.11.8442] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Although surgery is the first-choice treatment of primary hyperparathyroidism (pHPT), some patients present with contraindications or refuse surgery. Data from alternative nonsurgical therapies are inconclusive. To study the long-term efficacy of laser ablation in the treatment of pHPT, we retrospectively reviewed six cases of laser-treated patients. MATERIALS AND METHODS Six patients with pHPT were treated with laser ablation using a flat-tip technique. Energy was administered by means of one optic fiber placed into the parathyroid adenoma through a 21-gauge Chiba needle connected to a neodymium:yttrium-aluminum-garnet laser. The mean (± SD) delivered energy for all patients was 2.067 ± 1440 J (range, 1000-4200 J). Treatment was fractionated in two (n = 2 patients) or in three (n = 1 patient) ultrasound-guided sessions. Patients' serum parathyroid hormone (PTH) and calcium levels were checked periodically, with neck ultrasound performed. The mean duration of follow-up was 54 ± 34 months (range, 12-84 months). RESULTS Two months after laser ablation, serum PTH and calcium levels decreased in six and five patients, respectively. At the last follow-up examination, serum PTH and calcium levels were above the normal range in six and three patients, respectively. Three patients underwent surgery for persistent pHPT. Laser ablation therapy was safe and without permanent side effects. One patient reported transient dysphonia. CONCLUSION Laser ablation produces a transient reduction of serum PTH and calcium levels but not a lasting resolution of hyperparathyroidism. Laser cannot be proposed as the definitive therapy of pHPT. Thus, studies aiming to identify therapeutic algorithms specific for parathyroid glands are needed to verify the utility of laser ablation in pHPT.
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Diagnostic value of thyroglobulin assay in cervical lymph node fine-needle aspirations for metastatic differentiated thyroid cancer. Curr Opin Oncol 2013; 25:6-13. [DOI: 10.1097/cco.0b013e32835a9ab1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Yuan Y, Yue XH, Tao XF. The diagnostic value of dynamic contrast-enhanced MRI for thyroid tumors. Eur J Radiol 2012; 81:3313-8. [DOI: 10.1016/j.ejrad.2012.04.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 04/20/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
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Abstract
This review provides an overview of current guideline recommendations for the clinical evaluation and surgical management of well-differentiated thyroid cancer, and further examines the evidence for controversial topics such as the minimum degree of primary resection, the role of elective central neck dissection, and the extent of lateral neck dissection. Well-differentiated thyroid cancer comprises the majority of thyroid cancers, about 90%, and includes both papillary and follicular carcinomas. Despite convergence of the medical community in establishing treatment guidelines under the American Thyroid Association, there still remain many areas of disagreement.
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Affiliation(s)
- Selena Liao
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Sciences University, 3181 Southwest Sam Jackson Park Road, SJH01, Portland, OR 97239, USA.
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Abstract
Thyroid nodules are common entities, clinically important primarily because of their malignant potential. Serum thyrotropin and thyroid ultrasonography are pivotal in evaluating thyroid nodules. Fine-needle aspiration biopsy is the most accurate tool for diagnosing malignancy and selecting candidates for surgery. An approach to the initial evaluation and management of single nodules, functioning nodules, multinodular glands, incidental nodules, and cysts is discussed, as are therapeutic interventions for benign nodules. Thyroid cancer discovered during pregnancy is also discussed.
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Affiliation(s)
- Geanina Popoveniuc
- Division of Endocrinology, Georgetown University Medical Center, 4000 Reservoir Road, NW, Washington, DC 20007, USA
- Section of Endocrinology, Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010, USA
| | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, 4000 Reservoir Road, NW, Washington, DC 20007, USA
- Corresponding author. Division of Endocrinology, Georgetown University Medical Center, Suite 230, Building D, 4000 Reservoir Road, NW, Washington, DC 20007.
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Guide de bonnes pratiques pour l’usage de l’échographie cervicale et des techniques écho-guidées dans la prise en charge des cancers thyroïdiens différenciés de souche vésiculaire. ANNALES D'ENDOCRINOLOGIE 2011; 72:H1-26. [DOI: 10.1016/s0003-4266(11)70001-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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