The value of washout thyroglobulin levels in diagnosing cervical lymph node metastasis in papillary Thyroid carcinoma
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Abstract
Cervical lymph node metastasis is a common condition in patients with papillary thyroid carcinoma. Recently, fine-needle aspiration thyroglobulin measurement (FNA-Tg) has been recommended in the guidelines of the National Comprehensive Cancer Network and the American Thyroid Association to support the diagnosis of metastatic lymph nodes; however, this method remains relatively new in Vietnam. This study was conducted on 98 cervical lymph nodes from 47 patients with papillary thyroid carcinoma to evaluate the diagnostic value and determine the optimal cutoff value of FNA-Tg. The results showed that FNA-Tg levels of the cytology-positive group were significantly higher than the cytology-negative group (p = 0.000). The optimal cutoff value of FNA-Tg was 60 ng/mL, with a sensitivity of 90% and a specificity of 81.2%. The area under the ROC curve (AUC) was 0.92, and Cohen’s Kappa coefficient was 0.7 (p < 0.005), indicating that FNA-Tg is a highly valuable test and may be effectively applied in clinical practice for the diagnosis of cervical lymph node metastasis in papillary thyroid carcinoma.
Article Details
Keywords
FNA-Tg, metastatic cervical lymph nodes; papillary thyroid carcinoma (PTC)
References
2. Leenhardt L, Erdogan MF, Hegedus L, et al. 2013 European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques in the Postoperative Management of Patients with Thyroid Cancer. Eur Thyroid J. 2013; 2(3): 147-159. doi:10.1159/000354537.
3. Chung SR, Baek JH, Rho YH, et al. Sonographic Diagnosis of Cervical Lymph Node Metastasis in Patients with Thyroid Cancer and Comparison of European and Korean Guidelines for Stratifying the Risk of Malignant Lymph Node. Korean J Radiol. 2022; 23(11): 1102. doi:10.3348/kjr.2022.0358.
4. Haddad RI, Bischoff L, Applewhite M, et al. NCCN Guidelines® Insights: Thyroid Carcinoma, Version 1.2025: Featured Updates to the NCCN Guidelines®. Journal of the National Comprehensive Cancer Network. 2025; 23(7): e250033. doi:10.6004/jnccn.2025.0033.
5. Grani G, Fumarola A. Thyroglobulin in Lymph Node Fine-Needle Aspiration Washout: A Systematic Review and Meta-analysis of Diagnostic Accuracy. The Journal of Clinical Endocrinology & Metabolism. 2014; 99(6): 1970-1982. doi:10.1210/jc.2014-1098.
6. Chung SR, Baek JH, Choi YJ, et al. Diagnostic Algorithm for Metastatic Lymph Nodes of Differentiated Thyroid Carcinoma. Cancers. 2021; 13(6): 1338. doi:10.3390/cancers13061338.
7. Wang SR, Li QL, Tian F, et al. Diagnostic value of multiple diagnostic methods for lymph node metastases of papillary thyroid carcinoma: A systematic review and meta-analysis. Front Oncol. 2022; 12: 990603. doi:10.3389/fonc.2022.990603.
8. Jiang H, Hsiao P. Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review. The Kaohsiung J of Med Scie. 2020; 36(4): 236-243. doi:10.1002/kjm2.12173.
9. Pak K, Suh S, Hong H, et al. Diagnostic values of thyroglobulin measurement in fine-needle aspiration of lymph nodes in patients with thyroid cancer. Endocrine. 2015; 49(1): 70-77. doi:10.1007/s12020-014-0410-z.
10. Martins-Costa MC, Maciel RMB, Kasamatsu TS, et al. Clinical impact of thyroglobulin (Tg) and Tg autoantibody (TgAb) measurements in needle washouts of neck lymph node biopsies in the management of patients with papillary thyroid carcinoma. Arch Endocrinol Metab. 2017; 61(2): 108-114. doi:10.1590/2359-3997000000241.
11. Duval MA da S, Zanella AB, Cristo AP, Faccin CS, Graudenz MS, Maia AL. Impact of Serum TSH and Anti-Thyroglobulin Antibody Levels on Lymph Node Fine-Needle Aspiration Thyroglobulin Measurements in Differentiated Thyroid Cancer Patients. Eur Thyroid J. 2017; 6(6): 292-297. doi:10.1159/000479682.