title: The diagnostic value of thyroglobulin concentration in fine-needle aspiration of the cervical lymph nodes in patients with differentiated thyroid cancer.
abstract: BACKGROUND
  Recurrent differentiated thyroid cancer generally occurs first in the neck. Ultrasound is sensitive in detecting enlarged cervical lymph nodes but is not specific enough. Ultrasound-guided fine-needle biopsy increases the specificity but still may fail to detect a recurrence of the disease in the cystic metastatic lymph nodes. The aim of the study was to estimate the value of Tg concentration in the needle washout after fine-needle aspiration of suspicious lymph nodes.
  
  
  METHODS
  The 105 patients studied had presented one or more enlarged suspicious cervical lymph nodes. All had undergone total thyroidectomy and (131)I ablative therapy. Serum thyroglobulin (Tg) concentration was within the 0.15-711.5 ng/ml range (mean 22.24 ng/ml) and Tg recovery range 94-100%. The positive Tg washout concentration cut-off value was established as equal to the mean plus two standard deviations of the Tg washout concentration of patients with negative cytology.
  
  
  RESULTS
  Lymph node involvement was diagnosed by cytology in 15 patients and in 28 lymph nodes. Positive Tg washout concentration was found in 22 patients and in 48 lymph nodes. All the lymph nodes which turned out to have positive cytology had a positive Tg washout concentration. All lymph nodes with positive cytology were positive in pathology. Seven patients and 20 lymph nodes with negative cytology were positive in the Tg washout concentration test. All but one patients and all but two lymph nodes with a positive Tg washout concentration had positive pathology.
  
  
  CONCLUSIONS
  1. Ultrasound-guided fine-needle biopsy is not sensitive enough to detect all metastatic lymph nodes. 2. The Tg washout concentration test is 100% sensitive in the detection of metastatic lymph nodes. 3. Cytology in ultrasound- guided fine-needle biopsy is 100% specific. 4. The Tg washout concentration test carries a risk of false-positive results. 5. Both methods should be used for early detection of metastatic lymph nodes in patients with differentiated thyroid cancer.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Unit of Nuclear Medicine and Oncological Endocrinology, Medical University, Lodz. izotopy@wss.zgierz.pl
authors.forename: Sławomir
authors.initials: S
authors.lastname: Mikosiński
authors.forename: Lech
authors.initials: L
authors.lastname: Pomorski
authors.forename: Lidia
authors.initials: L
authors.lastname: Oszukowska
authors.forename: Jacek
authors.initials: J
authors.lastname: Makarewicz
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Adamczewski
authors.forename: Stanisław
authors.initials: S
authors.lastname: Sporny
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lewiński
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D044963:Biopsy, Fine-Needle; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000737:chemistry* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy; D013954:Thyroglobulin / Q000032:analysis*; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy
chemical_list: D014408:Biomarkers, Tumor; D013954:Thyroglobulin