Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytology?

BMC Clinical Pathology

Salvatore Ulisse⁴  Enrico De Antoni³  Paolo Miccoli¹  Eleonora D’Armiento⁵  Giovanni Carbotta⁵  Lucio Gnessi⁵  Alessandro Antonelli⁶  Corrado De Vito²  Cira Di Gioia⁷  Salvatore Sorrenti³  Enke Baldini⁵ 

[1] Department of Surgery, University of Pisa, Pisa, Italy;Department of Public Health and Infectious Diseases, “Sapienza” University of Rome, Rome, Italy;Department of Surgical Sciences, University of Rome, Rome, Italy;Department of Experimental Medicine, “Sapienza”, University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy;Department of Experimental Medicine, University of Rome, Rome, Italy;Department of Internal Medicine, University of Pisa, Pisa, Italy;Department of Radiological, Oncological and Anato-Pathological Sciences, University of Rome, Rome, Italy

关键词: Follow-up;    Fine-needle aspiration cytology;    Calcitonin;    Thyroglobulin;    Diagnosis;    Lymph node metastasis;    Thyroid cancer;   

Others  :  1085075
DOI  :  10.1186/1472-6890-13-7

 received in 2012-12-18, accepted in 2013-02-11,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Baldini et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 2010, 127:2893-2917.
• [2]Trimboli P, Ulisse S, Graziano FM, Marzullo A, Ruggieri M, Calvanese A, Piccirilli F, Cavaliere R, Fumarola A, D’Armiento M: Trend in thyroid carcinoma size, age at diagnosis and histology in a retrospective study of 500 cases diagnosed over 20 years. Thyroid 2006, 16:1151-1155.
• [3]Sherman SI: Thyroid carcinoma. Lancet 2003, 36:501-511.
• [4]Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA Jr, American Thyroid Association Guidelines Task Force: Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009, 19:565-612.
• [5]Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, Mclver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM, American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer: Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009, 19:1167-1214.
• [6]Schlumberger M, Berg G, Cohen O, Duntas L, Jamar F, Jarzab B, Limbert E, Lind P, Pacini F, Reiners C, Sánchez Franco F, Toft A, Wiersinga WM: Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol 2004, 150:105-112.
• [7]Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga W: European Thyroid Cancer Taskforce: European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 2006, 154:787-803.
• [8]Cervin JR, Silverman JF, Loggie BW, Geisinger KR: Virchow’s node revisited. Analysis with clinicopathologic correlation of 152 fine-needle aspiration biopsies of supraclavicular lymph nodes. Arch Pathol Lab Med 1995, 8:727-730.
• [9]Stack BC Jr, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, Sosa JA, Tufano RP: American Thyroid Association Surgical Affairs Committee: American thyroid association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 2012, 22:501-508.
• [10]Florentine BD, Staymates B, Rabadi M, Barstis J, Black A: Cancer Committee of the Henry Mayo Newhall Memorial Hospital: The reliability of fine-needle aspiration biopsy as the initial diagnostic procedure for palpable masses: a 4-year experience of 730 patients from a community hospital-based outpatient aspiration biopsy clinic. Cancer 2006, 107:406-416.
• [11]Cignarelli M, Triggiani V, Ciampolillo A, Ambrosi A, Giorgino F, Liso V, Giorgino R: High frequency of incidental diagnosis of extrathyroidal neoplastic diseases at the fine-needle aspiration biopsy of laterocervical lymph nodes in patients with thyroid nodules. Thyroid 2001, 11:65-71.
• [12]Ustün M, Risberg B, Davidson B, Berner A: Cystic change in metastatic lymph nodes: A common diagnostic pitfall in fine-needle aspiration cytology. Diagn Cytopathol 2002, 27:387-392.
• [13]Kessler A, Rappaport Y, Blank A, Marmor S, Weiss J, Graif M: Cystic appearance of cervical lymph nodes is characteristic of metastatic papillary thyroid carcinoma. J Clin Ultrasound 2003, 1:21-25.
• [14]Cignarelli M, Ambrosi A, Marino A, Lamacchia O, Campo M, Picca G, Giorgino F: Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic metastatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003, 13:1163-1167.
• [15]Borel AL, Boizel R, Faure P, Barbe G, Boutonnat J, Sturm N, Seigneurin D, Bricault I, Caravel JP, Chaffanjon P, Chabre O: Significance of low levels of thyroglobulin in fine needle aspirates from cervical lymph nodes of patients with a history of differentiated thyroid cancer. Eur J Endocrinol 2008, 158:691-698.
• [16]Snozek CL, Chambers EP, Reading CC, Sebo TJ, Sistrunk JW, Singh RJ, Grebe SK: Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin Endocrinol Metab 2007, 92:4278-4281.
• [17]Salmaslıoğlu A, Erbil Y, Cıtlak G, Ersöz F, Sarı S, Olmez A, Tunacı M, Yılmazbayhan D, Colak N, Ozarmağan S: Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary thyroid carcinoma. Langenbecks Arch Surg 2011, 396:77-81.
• [18]Kim MJ, Kim EK, Kim BM, Kwak JY, Lee EJ, Park CS, Cheong WY, Nam KH: Thyroglobulin measurement in fine-needle aspirate washout: the criteria for neck node dissection for patients with thyroid cancer. Clin Endocrinol 2009, 70:145-151.
• [19]Pacini F, Fugazzola L, Lippi F, Ceccarelli C, Centoni R, Miccoli P, Elisei R, Pinchera A: Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab 1992, 74:1401-1404.
• [20]Baskin HJ: Detection of recurrent papillary thyroid carcinoma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid 2004, 14:959-963.
• [21]Cunha N, Rodrigues F, Curado F, Ilhéu O, Cruz C, Naidenov P, Rascão MJ, Ganho J, Gomes I, Pereira H, Real O, Figueiredo P, Campos B, Valido F: Thyroglobulin detection in fine-needle aspirates of cervical lymph node: a technique for the diagnosis of metastatic differentiated thyroid cancer. Eur J Endocrinol 2007, 157:101-107.
• [22]Bournaud C, Charrié A, Nozières C, Chikh K, Lapras V, Denier ML, Paulin C, Decaussin-Petrucci M, Peix JL, Lifante JC, Cornu C, Giraud C, Orgiazzi J, Borson-Chazot F: Thyroglobulin measurement in fine-needle aspirates of lymph nodes in patients with differentiated thyroid cancer: a simple definition of the threshold value, with emphasis on potential pitfalls of the method. Clin Chem Lab Med 2010, 48:1171-1177.
• [23]Lee YH, Seo HS, Suh SI, Lee NJ, Kim JH, Seol HY, Lee JH, Kwon SY, Kim NH, Seo JA, Yang KS: Cut-off value for needle washout thyroglobulin in athyrotropic patients. Laryngoscope 2010, 120:1120-1124.
• [24]Frasoldati A, Toschi E, Zini M, Flora M, Caroggio A, Dotti C, Valcavi R: Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid 1999, 9:105-111.
• [25]Sohn YM, Kim MJ, Kim EK, Kwak JY: Diagnostic performance of thyroglobulin value in indeterminate range in fine needle aspiration washout fluid from lymph nodes of thyroid cancer. Yonsei Med J 2012, 53:126-131.
• [26]Giovanella L, Cerlani L, Suriano S, Crippa S: Thyroglobulin measurement on fine-needle washout fluids: influence of sample collection methods. Diagn Cytopathol 2009, 37:42-44.
• [27]Kim DW, Jeon SJ, Kim CG: Usefulness of thyroglobulin measurement in needle-washout of fine-needle aspiration biopsy for the diagnosis of cervical lymph node metastases from papillary thyroid cancer before thyroidectomy. Endocrine 2012, 42:399-403.
• [28]Pomorski L, Kaczka K, Piaskowski S, Wójcik I, Rieske P, Matejkowska M, Kuzdak K: Detection of lymph node metastases of papillary thyroid cancer – comparison of the results of histopathology, immunohistochemistry and reverse transcription-polymerase chain reaction – a preliminary report. Langenbecks Arch Surg 2005, 390:209-215.
• [29]Basciani S, Watanabe M, Mariani S, Passeri M, Persichetti A, Fiore D, Scotto D'Abusco A, Caprio M, Lenzi A, Fabbri A, Gnessi L: Hypogonadism in a patient with two novel mutations of the luteinizing hormone beta-subunit gene expressed in a compound heterozygous form. J Clin Endocrinol Metab 2012, 97:3031-3038.
• [30]Morgenthaler NG, Froehlich J, Rendl J, Willnich M, Alonso C, Bergmann A, Reiners C: Techincal evaluation of a new immunoradiometric and a new immunoluminometric assay for thyroglobulin. Clin Chem 2002, 48:1077-1083.
• [31]Boi F, Baghino G, Atzeni F, Lai ML, Faa G, Mariotti S: The diagnostic value for differentiated thyroid carcinoma metastases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph node is maintained in presence of circulating anti-Tg antibodies. J Clin Endocrinol Metab 2006, 91:1364-1369.
• [32]Cianfarani F, Baldini E, Cavalli A, Marchioni E, Lembo L, Teson M, Persechino S, Zambruno G, Ulisse S, Odorisio T, D'Armiento M: TSH receptor and thyroid specific genes expression in human skin. J Invest Dermatol 2010, 130:93-101.
• [33]Baldini E, Sorrenti S, Catania A, Guaitoli E, Prinzi N, Mocini R, Nardi F, D'Armiento E, Bianchini M, Favoriti P, Di Matteo FM, Ruggieri M, De Antoni E, Ulisse S: Diagnostic utility of thyroglobulin measurement in the fine needle aspirates from cervical lymph nodes: a case report. G Chir 2012, 33:387-391.