title: Preoperative serum thyroglobulin as a useful predictive marker to differentiate follicular thyroid cancer from benign nodules in indeterminate nodules.
abstract: Indeterminate cytology results increase the number of repetitive procedure and unnecessary surgery. This study was designed to find useful and simple predictive tools to differentiate malignant thyroid nodules from indeterminate nodules. We retrospectively enrolled 164 patients who had undergone thyroid surgery as a result of indeterminate cytology in the National Cancer Center. We reviewed patients' age at diagnosis, sex, preoperative biochemical markers such as thyroglobulin (Tg), anti-Tg antibody, free T4 and TSH level, and sonographical and pathological findings, which were subjected to statistical analysis. We found several clinical and sonographical predictive factors that showed significant differences. Young age, male, preoperative high Tg level, and hypoechoic nodule on sonography all increased cancer probability significantly in multivariate analysis. With a cut-off value of 187.5 ng/mL Tg, sensitivity and specificity were 54.8% and 90.1%, respectively (AUC 0.748, P < 0.001). In the case of nodule size > 1.7 cm, elevated serum Tg predicts the risk of malignancy; especially Tg > 70 ng/mL (odds ratio 3.245, 95% confidence interval 1.115-9.450, P = 0.038). Preoperative Tg levels had very high specificity in predicting thyroid cancer in case of suspicious follicular neoplasm. Therefore, Tg levels may be a useful marker for differentiating thyroid cancer from benign thyroid nodules in the cytological diagnosis of indeterminate nodules.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Lee
authors.forename: Ki-Wook
authors.initials: KW
authors.lastname: Chung
authors.forename: Hye Sook
authors.initials: HS
authors.lastname: Min
authors.forename: Tae Sung
authors.initials: TS
authors.lastname: Kim
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.forename: Jun Sun
authors.initials: JS
authors.lastname: Ryu
authors.forename: Yoo Seok
authors.initials: YS
authors.lastname: Jung
authors.forename: Seok Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: You Jin
authors.initials: YJ
authors.lastname: Lee
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013954:Thyroglobulin / Q000097:blood*; D016606:Thyroid Nodule / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D001323:Autoantibodies; D015415:Biomarkers; C006606:anti-thyroglobulin; D013954:Thyroglobulin