title: Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytology?
abstract: BACKGROUND
  Measurement of thyroglobulin (Tg) protein in the washout of the needle used for fine needle aspiration biopsy cytology (FNAB-C) has been shown to increase the sensitivity of FNAB-C in identifying cervical lymph node (CLN) metastasis from well-differentiated thyroid cancer (TC). In this study, we evaluated whether routine measurement of Tg protein (FNAB-Tgp), Tg mRNA (FNAB-Tgm) and calcitonin (CT) mRNA (FNAB-CTm) in the FNAB washout of CLN increases the accuracy of FNAB-C in the diagnosis of suspicious metastatic CLN.
  
  
  METHODS
  In this prospective study 35 CLN from 28 patients were examined. Histology showed metastatic papillary TC (PTC) in 26 CLN, metastatic medullary TC (MTC) in 3 CLN, metastatic anaplastic TC (ATC) in 3 CLN and 3 metastatic CLN from extra-thyroidal cancers.
  
  
  RESULTS
  The overall accuracy of FNAB-C was 84.4%, reaching 95.7% when the analysis was restricted to PTC. Both FNAB-Tgp and FNAB-Tgm compared favorably with FNAB-C and shown diagnostic performances not statistically different from that of FNAB-C. However, FNAB-Tgp and FNAB-Tgm/FNAB-CTm were found useful in cases in which cytology results were inadequate or provided diagnosis inconsistent with patient's clinical parameters.
  
  
  CONCLUSIONS
  We demonstrated that FNAB-C, Tg/CT mRNA and Tg protein determination in the fine-needle washout showed similar accuracy in the diagnosis of metastatic CLN from TC. The results of this study suggest that samples for Tg protein and Tg/CT mRNA measurements from CLN suspicious for metastatic TC should be collected, but their measurements should be restricted to cases in which FNAB-C provides uninformative or inconsistent diagnosis with respect to patient's clinical parameters.
authors: Department of Experimental Medicine, University of Rome, Rome, Italy.
authors: Enke
authors: E
authors: Baldini
authors: Department of Surgical Sciences, University of Rome, Rome, Italy.
authors: Salvatore
authors: S
authors: Sorrenti
authors: Department of Radiological, Oncological and Anato-Pathological Sciences, University of Rome, Rome, Italy.
authors: Cira
authors: C
authors: Di Gioia
authors: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
authors: Corrado
authors: C
authors: De Vito
authors: Department of Internal Medicine, University of Pisa, Pisa, Italy.
authors: Alessandro
authors: A
authors: Antonelli
authors: Department of Experimental Medicine, University of Rome, Rome, Italy.
authors: Lucio
authors: L
authors: Gnessi
authors: Department of Experimental Medicine, University of Rome, Rome, Italy.
authors: Giovanni
authors: G
authors: Carbotta
authors: Department of Experimental Medicine, University of Rome, Rome, Italy.
authors: Eleonora
authors: E
authors: D'Armiento
authors: Department of Surgery, University of Pisa, Pisa, Italy.
authors: Paolo
authors: P
authors: Miccoli
authors: Department of Surgical Sciences, University of Rome, Rome, Italy.
authors: Enrico
authors: E
authors: De Antoni
authors: Department of Experimental Medicine, University of Rome, Rome, Italy.|Department of Experimental Medicine, "Sapienza", University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
authors: Salvatore
authors: S
authors: Ulisse