title: A new approach for standardization and increased accuracy of lymph node washout thyroglobulin in patients with differentiated thyroid carcinoma.
abstract: BACKGROUND
  High values of fine needle aspiration washout thyroglobulin (FNAB-Tg) are diagnostic for metastatic lesions of thyroid cancer. However, there is not a consensus on cutoff for high FNAB-Tg level. In this study, we aimed to determine a more accurate and standardized parameter for FNAB-Tg.
  
  
  METHODS
  Ultrasonographically suspicious lymph nodes of patients with histopathologically confirmed differentiated thyroid cancer or malignant/suspicion for malignancy cytology were included. Tg washout was obtained by aspiration and nonaspiration fine needle biopsy (nonaspiration-FNB). Simultaneous Tg was measured from serum. Aspiration and washout procedures were also performed from whole blood and serum using syringes and needles identical to ones used for lymph node biopsy.
  
  
  RESULTS
  Data of 19 lesions in 17 patients who underwent lymph node dissection were analyzed. Nonaspiration FNB-Tg, FNAB-Tg/whole blood washout-Tg, nonaspiration FNB-Tg/whole blood washout-Tg, nonaspiration FNB-Tg/serum washout-Tg, nonaspiration FNB-Tg/serum Tg ratios were significantly higher in malignant lymph nodes compared to benign ones. Areas under the ROC curve for nonaspiration FNB-Tg, FNAB-Tg/whole blood washout-Tg, FNAB-Tg/serum washout-Tg, nonaspiration FNB-Tg/whole blood washout-Tg, nonaspiration FNB-Tg/serum washout-Tg, and nonaspiration FNB-Tg/serum Tg were statistically significant for the discrimination of benign and malignant lymph nodes. Best cutoff value for nonaspiration FNB-Tg was 4.21. Among ratios, best cutoff values were 5.40 for nonaspiration FNB-Tg/whole blood washout-Tg and 3.28 for nonaspiration FNB-Tg/serum washout-Tg.
  
  
  CONCLUSIONS
  For detection of malignant lymph nodes, determining ratios of nonaspiration FNB-Tg to whole blood and/or serum washout-Tg might be a promising method to increase accuracy and provide standardization of lymph node washout procedure.
authors.affiliation: School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Cevdet
authors.initials: C
authors.lastname: Aydin
authors.affiliation: School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Didem
authors.initials: D
authors.lastname: Ozdemir
authors.affiliation: School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Sacikara
authors.affiliation: School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Sefika Burcak
authors.initials: SB
authors.lastname: Polat
authors.affiliation: School of Medicine, Department of Pathology, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Aylin Kilic
authors.initials: AK
authors.lastname: Yazgan
authors.affiliation: School of Medicine, Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Seyda
authors.initials: S
authors.lastname: Turkolmez
authors.affiliation: School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Eda Demir
authors.initials: ED
authors.lastname: Onal
authors.affiliation: School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Reyhan
authors.initials: R
authors.lastname: Ersoy
authors.affiliation: School of Medicine, Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara.
authors.forename: Bekir
authors.initials: B
authors.lastname: Cakir
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods / Q000592:standards; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000473:pathology*
chemical_list: D013954:Thyroglobulin
keywords: differentiated thyroid cancer; lymph node washout; thyroglobulin