title: Improvement in the Detection of Cystic Metastatic Papillary Thyroid Carcinoma by Measurement of Thyroglobulin in Aspirated Fluid.
abstract: Cystic change in metastatic lymph nodes of papillary thyroid carcinoma (PTC) is a diagnostic challenge for fine needle aspiration (FNA) because of the scant cellularity. The aim of this study was to evaluate the measurement of thyroglobulin in fine needle aspirate (Tg-FNA) for detecting metastatic PTC in patients with cystic neck lesions and to validate the optimal cutoff value of Tg-FNA. A total of 75 FNA specimens of cystic lesions were identified, including 40 of metastatic PTC. Predetermined threshold levels of 0.04 (minimum detection level), 0.9, 10.0, and 77.0 ng/mL (maximum normal serum-Tg level) were used to evaluate the diagnostic accuracy of Tg-FNA for metastatic PTC detection. The areas under the receiver operating characteristic curve for diagnosing metastatic PTC of Tg-FNA values of 0.04, 0.9, 10.0, and 77.0 ng/mL were 0.5 (95% confidence interval [CI], 0.382-0.618), 0.645 (95% CI, 0.526-0.752), 0.945 (95% CI, 0.866-0.984), and 0.973 (95% CI, 0.907-0.996), respectively. With a cutoff value of 77.0 ng/mL, the combination of Tg-FNA and FNA cytology showed superior diagnostic power (97.5% sensitivity and 100% specificity) compared to FNA cytology alone (80% sensitivity and 100% specificity). We recommend a Tg-FNA cutoff of 77.0 ng/mL, the maximum normal serum-Tg level, for cystic neck lesions.
authors.affiliation: Department of Diagnostic Ultrasound, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Pathology, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.
authors.forename: Huan
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
authors.forename: Yi-Xiang J
authors.initials: YX
authors.lastname: Wang
authors.affiliation: Department of Clinical Library, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.
authors.forename: Min-Jie
authors.initials: MJ
authors.lastname: Wang
authors.affiliation: Department of Pathology, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.
authors.forename: Zhi-Hui
authors.initials: ZH
authors.lastname: Zhang
authors.affiliation: Department of Cancer Epidemiology, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Head & Neck Surgery, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
authors.forename: Anil T
authors.initials: AT
authors.lastname: Ahuja
authors.affiliation: Department of Diagnostic Imaging, Cancer Hospital & Institute, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.
authors.forename: Chun-Wu
authors.initials: CW
authors.lastname: Zhou
authors.affiliation: Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
authors.forename: Yu-Xin
authors.initials: YX
authors.lastname: Jiang
authors.affiliation: Department of Pathology, Cancer Hospital & Institute, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100021, China.
authors.forename: Hui-Qin
authors.initials: HQ
authors.lastname: Guo
mesh_terms: D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D002291:Carcinoma, Papillary; D003581:Cytodiagnosis; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D013954:Thyroglobulin / Q000235:genetics / Q000302:isolation & purification*; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology
chemical_list: D013954:Thyroglobulin