The role of thyroglobulin detection in washout fluid from fine-needle aspiration biopsies to diagnose gland metastases in thyroid cancer follow up
DOI:
https://doi.org/10.29193/RMU.38.3.1Keywords:
THYROGLOBULIN, THYROID CANCER, PUNCTURES, ADENOPATHIESAbstract
Recurrence of differentiated thyroid cancer (DTC) in the cervix is 5-20% of cases. Fine-needle aspiration cytology of adenopathies has been used to confirm ultrasound findings when suspicions of being malignant.
The study aims to evaluate usefulness of fine-needle aspiration of lymph gland to diagnose gland metastases in patients over 18 years old under papillary thyroid cancer follow-up. Retrospective, descriptive and observational study in a 14-patient-sample, mainly female
(71,4%), with an average age of 40.9 ± 2.9 years old.
Results: single tumor focus papillary thyroid cancer was the most common type of thyroid cancer found. 50% of the 22 suspicious glands had FNATg ≥1ng/ml. All reactive adenitis had measurements < 1ng/ml, whereas metastatic adenopathies results were ≥ 1ng/ml. 85.7% of patients had anti-TG Ac ≥ 1ng/ml (5 patients with FNATg values ≥1ng/ml and 7 patients with
FNATg < 1ng/ml), 14.3% of which obtained results < 10 UI/ml (all of them with FN1 ng/ml). Gland emptying was performed in 4 cases, and papillary thyroid cancer metastases was found in all of them.
Conclusions: FNATg is a good study to diagnose gland metastases in patients under differentiated thyroid cancer follow-up. Given the results of this study, supported
by a bibliographic search, the use of FNATg has a great diagnostic value to detect gland metastases in the follow up of differentiated thyroid cancer, and thus it is recommended along with cytological and/or pathology studies.
References
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13) Spencer C, Fatemi S. Thyroglobulin antibody (TgAb) meth¬ods - Strengths, pitfalls and clinical utility for monitoring TgAb-positive patients with differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2013; 27(5):701-12. doi: 10.1016/j.beem.2013.07.003.
14) Boi F, Baghino G, Atzeni F, Lai ML, Faa G, Mariotti S. The diagnostic value for differentiated thyroid carcinoma metas¬tases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies. J Clin Endocrinol Metab 2006; 91(4):1364-9. doi: 10.1210/ jc.2005-1705.
15) Costante G, Filetti S. Diagnosis: thyroglobulin in fine-nee¬dle aspirates-a clue to metastasis? Nat Rev Endocrinol 2009; 5(5):249-50. doi: 10.1038/nrendo.2009.55.
16) Frasoldati A, Toschi E, Zini M, Flora M, Caroggio A, Dotti C, et al. Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid 1999; 9(2):105-11. doi: 10.1089/thy.1999.9.105.
17) Snozek CL, Chambers EP, Reading CC, Sebo TJ, Sistrunk JW, Singh RJ, et al. Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin En-docrinol Metab 2007; 92(11):4278-81. doi: 10.1210/jc.2007- 1075.
18) Cunha N, Rodrigues F, Curado F, Ilhéu O, Cruz C, Naidenov P, et al. Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: A technique for the diagnosis of met¬astatic differentiated thyroid cancer. Eur J Endocrinol 2007; 157(1):101-7. doi: 10.1530/EJE-07-0088.
19) Cignarelli M, Ambrosi A, Marino A, Lamacchia O, Cam¬po M, Picca G, et al. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic met¬astatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003; 13(12):1163-7. doi: 10.1089/10507250360731578.
20) Baskin HJ. Detection of recurrent papillary thyroid carcino¬ma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid 2004; 14(11):959-63. doi: 10.1089/thy.2004.14.959.
21) Sigstad E, Heilo A, Paus E, Holgersen K, Groholt KK, Jor¬gensen LH, et al. The usefulness of detecting thyroglobulin in fine-needle aspirates from patients with neck lesions us¬ing a sensitive thyroglobulin assay. Diagn Cytopathol 2007; 35(12):761-7. doi: 10.1002/dc.20726.
22) Duval da Silveira MA, Zanella AB, Cristo AP, Faccin CS, Graudenz MS, Maia AL. Impact of serum TSH and an¬ti-thyroglobulin antibody levels on lymph node fine-needle aspiration thyroglobulin measurements in differentiated thy¬roid cancer patients. Eur Thyroid J 2017; 6(6):292-7. doi: 10.1159/000479682.
23) Li J, Zhang K, Liu X, Hao F, Liu Z, Wang Z. Cervical lymph node thyroglobulin measurement in washout of fine-needle aspirates for diagnosis of papillary thyroid can¬cer metastases. Br J Biomed Sci 2016; 73(2):79-83. doi: 10.1080/09674845.2016.1173334.
24) Baldini E, Sorrenti S, Di Gioia C, De Vito C, Antonelli A, Gnessi L, et al. Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytolo¬gy? BMC Clin Pathol 2013; 13:7. doi: 10.1186/1472-6890- 13-7.
25) Salmaslioglu A, Erbil Y, Cıtlak G, Ersöz F, Sarı S, Olmez A, et al. Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary thyroid carcinoma. Langen¬becks Arch Surg 2011; 396(1):77-81. doi: 10.1007/s00423- 010-0723-1.
26) Aydin C, Ozdemir D, Sacikara M, Polat SB, Yazgan AK, Turkolmez S, et al. A new approach for standardization and increased accuracy of lymph node washout thyroglobulin in patients with differentiated thyroid carcinoma. Diagn Cyto¬pathol 2016; 44(3):177-86. doi: 10.1002/dc.23414.
2) M. Cecilia Martins-Costa1,2, Rui M. B. Maciel1,3,4, Tere¬sa S. Kasamatsu1, et al, Clinical impact of thyroglobulin (Tg) and Tg autoantibody (TgAb) measurements in needle washouts of neck lymph node biopsies in the management of patients with papillary thyroid carcinoma,vol - 61,DOI - 10.1590/2359-3997000000241,Archives of Endocrinology and Metabolism
3) Konca Degertekin C, Yalcin MM, Cerit T, Ozkan C, Kalan I, Iyidir OT, et al. Lymph node fine-needle aspiration washout thyroglobulin in papillary thyroid cancer: diagnostic value and the effect of thyroglobulin antibodies. Endocr Res 2016; 41(4):281-9. doi: 10.3109/07435800.2016.1141936.
4) Lee JH, Lee HC, Yi HW, Kim BK, Bae SY, Lee SK, et al. Influence of thyroid gland status on the thyroglobulin cutoff level in washout fluid from cervical lymph nodes of patients with recurrent/metastatic papillary thyroid cancer. Head Neck 2016; 38(Suppl 1):E1705-12. Disponible en: https:// pubmed.ncbi.nlm.nih.gov/26614648/ [Consulta: 12 abril 2021]. doi: 10.1002/hed.24305.
5) Al-Hilli Z, Strajina V, McKenzie TJ, Thompson GB, Farley DR, Regina Castro M, et al. Thyroglobulin measurement in fine-needle aspiration improves the diagnosis of cervical lymph node metastases in papillary thyroid carcinoma. Ann Surg Oncol 2017; 24(3):739-44. doi: 10.1245/s10434-016- 5625-1.
6) Pacini F, Fugazzola L, Lippi F, Ceccarelli C, Centoni R, Mic¬coli P, et al. Detection of thyroglobulin in fine needle aspi¬rates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab 1992; 74(6):1401-4. Disponible en: https://pubmed. ncbi.nlm.nih.gov/1592886/ [Consulta: 15 agosto 2021] doi: 10.1210/jcem.74.6.1592886.
7) Tuttle R. Didderentiated thyroid cancer: overview of management. En: Shefner JM, ed. UpToDate. Waltham, MA: UpToDate, 2022. Disponible en: https://www.up¬todate.com/contents/differentiated-thyroid-cancer-over¬view-of-management?search=C%C3%A1ncer%20de%20 tiroides%20diferenciado&source=search_result&selected-Title=1~150&usage_type=default&display_rank=1 [Con¬sulta:1º noviembre 2021].
8) Pitoia F, Califano I, Vázquez A, Faure E, Gauna A, Orlandi A, et al. Consenso intersocietario∗ sobre tratamiento y se-guimiento de pacientes con cáncer diferenciado de tiroides. Rev Argent Endocrinol Metab 2014; 51(2):85-118.
9) Rico-Morlán FJL, Hernández-Cuéllar A, Martínez-Macías R, Barra-Martínez R, Santiago-Vázquez RY. Niveles séricos de tiroglobulina como marcador de malignidad en pacientes con nódulo tiroideo. GAMO 2009; 8(2):54-61.
10) Harish K. Thyroglobulin: current status in differentiated thy¬roid carcinoma (review). Endocr Regul 2006; 40(2):53-67.
11) Tuttle R. Differentiated thyroid cancer: role of serum thy¬roglobulin. En: Shefner JM, ed. UpToDate. Waltham, MA: UpToDate, 2021. Disponible en: https://www.uptodate. com/contents/differentiated-thyroid-cancer-role-of-se¬rum-thyroglobulin?search=C%C3%A1ncer%20de%20tiroi¬des%20diferenciado&source=search_result&selectedTi-tle=4~150&usage_type=default&display_rank=4 [Consulta: 1º noviembre 2021].
12) Teres I, Astarita G, Mesch V, Mosquera Filoso G, Esteban MP, Kozac A, et al. Métodos de tiroglobulina de primera y segunda generación: su utilidad en pacientes con cáncer dif¬erenciado de tiroides. Rev Argent Endocrinol Metab 2017; 54(3):101-8. doi: 10.1016/j.raem.2017.05.002.
13) Spencer C, Fatemi S. Thyroglobulin antibody (TgAb) meth¬ods - Strengths, pitfalls and clinical utility for monitoring TgAb-positive patients with differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2013; 27(5):701-12. doi: 10.1016/j.beem.2013.07.003.
14) Boi F, Baghino G, Atzeni F, Lai ML, Faa G, Mariotti S. The diagnostic value for differentiated thyroid carcinoma metas¬tases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies. J Clin Endocrinol Metab 2006; 91(4):1364-9. doi: 10.1210/ jc.2005-1705.
15) Costante G, Filetti S. Diagnosis: thyroglobulin in fine-nee¬dle aspirates-a clue to metastasis? Nat Rev Endocrinol 2009; 5(5):249-50. doi: 10.1038/nrendo.2009.55.
16) Frasoldati A, Toschi E, Zini M, Flora M, Caroggio A, Dotti C, et al. Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid 1999; 9(2):105-11. doi: 10.1089/thy.1999.9.105.
17) Snozek CL, Chambers EP, Reading CC, Sebo TJ, Sistrunk JW, Singh RJ, et al. Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin En-docrinol Metab 2007; 92(11):4278-81. doi: 10.1210/jc.2007- 1075.
18) Cunha N, Rodrigues F, Curado F, Ilhéu O, Cruz C, Naidenov P, et al. Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: A technique for the diagnosis of met¬astatic differentiated thyroid cancer. Eur J Endocrinol 2007; 157(1):101-7. doi: 10.1530/EJE-07-0088.
19) Cignarelli M, Ambrosi A, Marino A, Lamacchia O, Cam¬po M, Picca G, et al. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic met¬astatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003; 13(12):1163-7. doi: 10.1089/10507250360731578.
20) Baskin HJ. Detection of recurrent papillary thyroid carcino¬ma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid 2004; 14(11):959-63. doi: 10.1089/thy.2004.14.959.
21) Sigstad E, Heilo A, Paus E, Holgersen K, Groholt KK, Jor¬gensen LH, et al. The usefulness of detecting thyroglobulin in fine-needle aspirates from patients with neck lesions us¬ing a sensitive thyroglobulin assay. Diagn Cytopathol 2007; 35(12):761-7. doi: 10.1002/dc.20726.
22) Duval da Silveira MA, Zanella AB, Cristo AP, Faccin CS, Graudenz MS, Maia AL. Impact of serum TSH and an¬ti-thyroglobulin antibody levels on lymph node fine-needle aspiration thyroglobulin measurements in differentiated thy¬roid cancer patients. Eur Thyroid J 2017; 6(6):292-7. doi: 10.1159/000479682.
23) Li J, Zhang K, Liu X, Hao F, Liu Z, Wang Z. Cervical lymph node thyroglobulin measurement in washout of fine-needle aspirates for diagnosis of papillary thyroid can¬cer metastases. Br J Biomed Sci 2016; 73(2):79-83. doi: 10.1080/09674845.2016.1173334.
24) Baldini E, Sorrenti S, Di Gioia C, De Vito C, Antonelli A, Gnessi L, et al. Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytolo¬gy? BMC Clin Pathol 2013; 13:7. doi: 10.1186/1472-6890- 13-7.
25) Salmaslioglu A, Erbil Y, Cıtlak G, Ersöz F, Sarı S, Olmez A, et al. Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary thyroid carcinoma. Langen¬becks Arch Surg 2011; 396(1):77-81. doi: 10.1007/s00423- 010-0723-1.
26) Aydin C, Ozdemir D, Sacikara M, Polat SB, Yazgan AK, Turkolmez S, et al. A new approach for standardization and increased accuracy of lymph node washout thyroglobulin in patients with differentiated thyroid carcinoma. Diagn Cyto¬pathol 2016; 44(3):177-86. doi: 10.1002/dc.23414.
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2022-10-12
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Pritsch C, Finozzi R, Neira N. The role of thyroglobulin detection in washout fluid from fine-needle aspiration biopsies to diagnose gland metastases in thyroid cancer follow up. Rev. Méd. Urug. [Internet]. 2022 Oct. 12 [cited 2024 Sep. 7];38(3):e38302. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/894
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