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1. Role of Thyroglobulin Measurement in Fine-Needle Aspiration Biopsies of Cervical Lymph Nodes in Patients with Differentiated Thyroid Cancer

Author

Claudio Dotti, Michele Zini, Elena Toschi, Andrea Frasoldati, Angelo Caroggio, Roberto Valcavi, and Marcella Flora

Subjects
Adult, Male, endocrine system, Pathology, medicine.medical_specialty, endocrine system diseases, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Sensitivity and Specificity, Thyroglobulin, Endocrinology, Humans, Medicine, In patient, Thyroid Neoplasms, Thyroid cancer, Aged, Thyroglobulin Measurement, medicine.diagnostic_test, business.industry, Biopsy, Needle, Thyroid, Thyroidectomy, Cell Differentiation, Middle Aged, medicine.disease, Fine-needle aspiration, medicine.anatomical_structure, Cervical lymph nodes, Lymphatic Metastasis, Female, Lymph Nodes, business, Neck, Neck lymph nodes
Abstract

The identification of metastatic neck lymph nodes in patients awaiting surgery for differentiated thyroid tumor permits their excision during thyroidectomy. In order to detect thyroid cancer lymphatic metastasis before surgery, we measured thyroglobulin (Tg) in the needle wash-out of fine-needle aspiration biopsy (FNAB). Ultrasound-guided FNAB on enlarged neck nodes was performed in 23 patients awaiting surgery for differentiated thyroid tumor (n = 33 lymph nodes), 47 patients previously thyroidectomized for thyroid tumor (n = 89 lymph nodes), and 60 patients without thyroid disease (n = 94 lymph nodes). Immediately after aspiration biopsy, the needle was rinsed with 1 mL of normal saline solution and Tg levels were measured on the needle wash-out (FNAB-Tg). FNAB-Tg levels were markedly elevated in metastatic lymph nodes both in patients awaiting thyroidectomy (metastatic vs. negative lymph nodes, mean +/- SEM, 16,593 +/- 7,050 ng/mL vs. 4.91 +/- 1.61 ng/mL; p0.001) and in thyroidectomized patients (11,541 +/- 7,283 ng/mL vs. 0.45 +/- 0.07 ng/mL; p0.001). FNAB-Tg sensitivity, evaluated through histological examination in 69 lymph nodes, was 84.0%. The combination of cytology plus FNAB-Tg increased FNAB sensitivity from 76% to 92.0%. In conclusion, FNAB-Tg measurement is a useful technique for early diagnosis of lymph node metastasis originating from differentiated thyroid cancer.

Published
1999
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2. Prognostic Factors Affecting Neck Lymph Node Recurrence and Distant Metastasis in Papillary Microcarcinoma of the Thyroid: Results of a Study in 445 Patients.

Author

Giuseppe Mercante, Andrea Frasoldati, Corrado Pedroni, Debora Formisano, Luigi Renna, Simonetta Piana, Giorgio Gardini, Roberto Valcavi, and Verter Barbieri

Subjects
*LYMPH node diseases, *NECK diseases, *METASTASIS, *CANCER relapse, *THYROID cancer, *CANCER patients, *DISEASE management, *THYROIDECTOMY, *PROGNOSIS
Abstract

Background:The management of thyroid papillary microcarcinoma (PMC) is controversial. Total thyroidectomy, thyroid lobectomy/isthmectomy, and even no treatment have been proposed. We investigated the clinical course and prognostic factors for disease recurrence and distant metastasis in 445 patients with PMC.Methods:Data from 445 patients diagnosed with PMC in the period from 1978 to 2003 were reviewed and analyzed. Total thyroidectomy was performed in 404 patients and loboisthmusectomy in 41. Neck dissection took place in 226 patients (49.7%), with 166 of only the central compartment and 60 of both the central and lateral compartments. Radioiodine (131I) ablation treatment was given to 389 patients.Results:Median tumor size was 7 mm (range 1–10 mm). PMC was multifocal in 156 cases (35%) and bilateral in 60 cases (13.5%). Extrathyroidal tumor extension (pT3) and neck lymph node metastasis (pN1) were present in 133 (30%) and 182 (40.9%) patients, respectively. Capsular invasion without extrathyroidal tumor extension was observed in 39 (8.7%) patients. Mean follow-up was 5.3 (range 1–26) years. Seventeen (3.8%) patients had recurrence or persistence of disease: neck recurrence (NR) in 12 (2.7%), distant metastasis (DM) in four (0.9%), NR + DM in one (0.2%). One patient (0.2%) died of the disease. Capsular invasion, extrathyroidal tumor extension (pT3), and neck lymph node metastasis at presentation (pN1) were the only independent risk factors for NR and/or DM occurrence (p< 0.05). Patients not showing these features, who were treated with loboisthmusectomy only, never experienced disease recurrence.Conclusion:Total thyroidectomy seems advisable in PMC with extrathyroidal extension and neck lymph node metastasis at presentation. Capsular invasion without extrathyroidal extension may suggest aggressive tumor behavior and require radical treatment. [ABSTRACT FROM AUTHOR]

Published
2009
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