| BackgroundThyroglobulin measurement in ine-needle aspiration biopsy, FNATg, which rise in foreign countries since 1992 that F Pacini reported in this years [1]. with the progress of research during more than ten years, FNATg technology Progressively developed and Improved. Further more, it got the American Thyroid Association (ATA) approved, and was included into the latest version of Management Guidelines for Patients with Thyroid Nodules and differentiated Thyroid Cancer, while the selection of methods and means and the study of influence factor made significant progress. However, at home, FNATg technology has not yet attracted sufficient attention. This paper discusses the application of FNATg, determines an appropriate diagnostic thresholdvalue, and evaluates its application.Objective1, To comparatively research the diagnose of cervical lymph node metastasis by FNATg and cytology. 2, To determine an appropriate diagnostic thresholdvalue for Tg levels in FNA washout fluid in patients with neck nodemetastases or recurrences of DPTC. 3, Through retrospective studies, to reseach the influence factors of FNATg form clinical study, and to standardize the methods FNATg . 4, FNATg combining with FNAC is used for the diagnosis of metastatic cervical lymph nodes and clinical treatment. MethodsA total of 30 ultrasonographically detected lymph nodes from 30 patients at our department with PTC were included between August 2010 and April 2011. FNA was performed on an extended neck by fine needle under US guidance and free-hand technique. after the aspiration samples were expelled onto glass slides for cytological examination and smeared. Tg in needle washout was assayed with electrochemical luminescence immunoassay (ECLIA). Intraoperative FNATg was perfomend on 6 lymph nodes marked . All the lymph nodes was suffer from the surgical dissection and Final lymph node status was determined from histology reports of surgical lymph node specimens. we used three FNATg cutoff level determining positivity.ResultsWe evaluated diagnostic sensitivity, specificity and accuracy of metastasis detection according to several predetermined threshold levels: 10ng/ml, mean+2SD of node-negative patients, and FNA-Tg/serum-Tg > 1. FNA-Tg levels showed 100.0%, 89.5%, 89.5% sensitivity, 63.6%, 90.9%, 90.9% specificity, 86.7%, 90.0%, 90.0% accuracy with the threshold of FNA-Tg level at 10 ng/ml, serum-Tg or mean+2SD of FNA-Tg measured in node-negative patients. There was no significant difference in the sensitivity and specificity among the three threshold levels (P> 0?05). The sensitivities, specificities and accuracies of FNAB-cytology, FNAB-Tg, and US were89.5%, 90.9% and 90.0%; 63.2%, 100.0% and 76.7%; 73.7%, 90.9% and 80.0%, respectively. The diagnostic sensitivity of FNAB-Tg for metastatic nodes was significantly higher than that of FNAB-cytology (p = 0.011). Furthermore, combined FNAB-Tg/cytology significantly increased sensitivity as compared with FNAB-cytology. When we used CV-FNA-Tg for determining positivity, the result of introperative FNATg consistent with the preoperative.Conclusion1. Combined FNAB-cytology/Tg is more sensitive and accurate for the diagnosis of metastatic cervical lymph nodes from PTC than FNAB-cytology alone. 2. Diagnostic FNATg for detecting metastatic lymph nodes in patients with papillary thyroid cancer have high sensitivities and accuracies. 3. CV-FNA-Tg should be used for determining positivity. 4. FNATg can help introperative and preoperative diagnosis of metastatic lymph nodes in patients with papillary thyroid cancer. 5. FNATg can be used as an indicator for follow-up of patinents suffered from PTC. |
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