| Objective:To discuss the clinical value of the thyroglobulin(Tg)confirmation test to determine preoperative serum Tg and washout fluid thyroglobulin in fine needle aspiration(FNA-Tg)in diagnosing lymph node metastasis with dfferentiated thyroid cancer(DTC).Methods:A total of 431 patients diagnosed with thyroid cancer in Affiliated Hospital of Zunyi Medical University from December 1,2020 to December 1,2021 were selected as subjects for a prospective study.Organize the collected case clinical data and sorted out,including:gender,age,history of thyroiditis,etc.Preoperative serum thyroid index detection was improved after admission,postoperative pathological diagnosis results.According to the postoperative pathology as the gold standard,431 patients were divided into 2 groups,222 cases with cervical lymph node metastasis were the metastasis group,209 cases without cervical lymph node metastasis were the non-metastatic group.The groups were grouped according to the reference intervals of the laboratory’s testing methodology,73 patients with serum antithyroglobulin(Tg Ab)≥115IU/m L were Tg Ab+group,and 358 patients with serum Tg Ab<115IU/m L were Tg Ab-group.The serum samples were tested by Tg confirmation test,and the obtained preoperative Tg1 was the preoperative Tg without Tg confirmation test.A total of 151 lymph nodes from 120patients were collected in the study,and undergoing FNA-Tg.The clinical value of FNA-Tg1 determined by Tg confirmation test and FNA-Tg in diagnosing metastasis lymph node of DTC was analyzed based on the patholobical results as the gold standard.IBM SPSS21.0 version was used for statistical analysis of the data,P<0.05 was considered statistically significant.Results:In this study,222 patients in the metastatic group and 209 patients in the non-metastatic group,there were no significant difference in age or sex(P>0.05).Preoperative Tg 1and Tg levels in the metastatic group,which were significantly higher than those in the non-metastatic group(Z=-2.953,P=0.003;Z=-2.82,P=0.005).The median maximum diameter of metastatic group was 0.9cm,and that of non-metastatic group was 0.5cm,with significant difference between the two groups(Z=-6.945,P<0.001).The area under the curve(AUC)of preoperative Tg1 diagnosis of DTC cervical lymph node metastasis was 0.704(95%CI:0.648-0.761,P<0.001),the optimal critical value was72.8ng/m L,the sensitivity was 80.1%,and the specificity was 52.8%.The preoperative Tg level for diagnosing cervical lymph node metastasis of DTC was 0.691(95%CI:0.634-0.749,P<0.001),the optimal critical value was 13.37ng/m L,the sensitivity was 84.5%,and the specificity was 45.3%.The preoperative median Tg1and Tg in the Tg Ab+group were significantly lower than those in Tg Ab-group,with statistically significant differences(Z=-7.634,P<0.001).The 431 patients with preoperative Tg levels were divided into three subgroups according to≥77ng/m L,3.5-77ng/m L and<3.5ng/m L.Aanalyzing the proportion of different preoperative Tg levels in the metastatic group and the non-metastatic group,and the difference was statistically significant(χ~2=9.25,P=0.01).The preoperative Tg level of the mass with the largest diameter≥1cm was higher than that of the mass with the largest diameter<1cm,and the difference between the two groups was statistically significant(Z=-4.758,P<0.001).Logistic regression analysis showed that the preoperative Tg(OR=1.004,95%C.I.1.000-1.008,P=0.048)and the maximum tumor diameter(OR=4.757,95%CI:2.799-8.084,P<0.001),Spearman correlation analysis showed positive correlation(r=0.143;r=0.335;P<0.05).The critical values of FNA-Tg and FNA-Tg1 for the diagnosis of cervical lymph node metastasis of DTC were8.9ng/m L and 102.1ng/m L,The sensitivity,specificity and accuracy of fine needled aspiration cytology(FNAC)and FNA-Tg in diagnosing DTC cervical lymph node metastasis were 60.7%,95.4%and 76.1%,respectively.74.1%,86.3%,78.1%.Conclusions:1、In this study,preoperative Tg1 level>72.8ng/m L and Tg level>13.37ng/m L detected by Tg confirmation test were the optimal critical values for diagnosis of DTC lymph node metastasis.The diagnostic value of Tg1 confirmation test was significantly better than Tg in Tg Ab positive patients.However,the application value in all DTC patients is further discussed.2、Preoperative increases in Tg1 and Tg levels were both related to the maximum tumor diameter,which combined with the tumor diameter had high clinical value in the diagnosis of DTC lymph node metastasis3、Preoperative Tg1 level>72.8ng/m L,Tg level>13.37ng/m L,and the maximum tumor diameter≥1cm were important criteria for diagnosing DTC lymph node metastasis.4、In this study,the critical values of FNA-Tg and FNA-Tg1 for the diagnosis of DTC lymph node metastasis were 8.9ng/m L and 102.1ng/m,respectively.Preoperative FNA-Tg improved the accuracy of the diagnosis of cervical metastatic lymph nodes of DTC and contributed to the preoperative evaluation of lymph node metastasis.5、In this study,it was found that simultaneous FNA-Tg detection of FNAC significantly improved the diagnostic efficiency of cervical lymph nodes of DTC,and FNA-Tg detection can be used as a powerful supplement to FNAC detection technology.6、In this study,it was found that FNA-Tg combined with Tg confirmation test did not bring more diagnostic value to the clinic,and its value needs more research. |
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