甲状腺乳头状癌术后疑似转移淋巴结细针穿刺液中甲状腺球蛋白检测的意义

The significance for thyroglobulin detection in suspicious cervical lymph node fine-needle aspirate washout fluid after surgery in papillary thyroid carcinoma patients

目的通过检测颈部转移淋巴结细针穿刺(FNA)洗脱液中甲状腺球蛋白(Tg)的变化,为判断淋巴结中是否有甲状腺乳头状癌(PTC)转移提供依据。方法收集PTC术后颈部可疑淋巴结B超引导下的FNA洗脱液标本109例,以颈部反应性增生淋巴结洗脱液标本16例作为对照组。采用免疫化学发光检测标本的Tg值,结合组织病理结果回顾性分析FNA-Tg方法判断转移性淋巴结的符合度。比较FNA-Tg法与传统细胞学方法对转移淋巴结的阳性检出率。对穿刺涂片中的吞噬细胞及肿瘤细胞计数并根据结果分为4组,采用秩和检验分析不同细胞成分对Tg值检测的影响。结果 109例淋巴结洗脱液中,84例FNA-Tg阳性的标本与最终组织病理结果一致,为转移性淋巴结。细胞学方法对单纯PTC转移淋巴结的检出率为93.9%,对PTC转移伴囊性变淋巴结的检出率为88.6%;FNA-Tg法在单纯PTC转移及PTC转移伴囊性变淋巴结中的检出率均为100%。细胞分类结果表明肿瘤细胞数目与FNA-Tg值的变化无明显差异,而囊性变吞噬细胞可见组FNA-Tg检测值显著高于未见吞噬细胞组(U=367.00,P<0.01)。结论淋巴结FNA洗脱液中的Tg可作为诊断PTC淋巴结转移的参考标志物。在转移灶伴有囊性变的淋巴结中,FNA-Tg法可提高阳性淋巴结的检出灵敏度。细胞学涂片中吞噬细胞的存在对肿瘤的转移有提示作用。

Objective To determine the change of thyroglobulin（Tg） in fine-needle aspirate（FNA） of cervical lymph node（CLN） in order to provide the reference of papillary thyroid carcinoma（PTC） metastasis identification in lymph node Under ultrasound-guided FNA,109 samples from patients that were suspicious for metastatic PTC were collected,and 16 samples from patients whose cervical lymph nodes diagnosed as reactive were used as control group.FNA-Tg levels were measured by immunochemiluminescence assay.Then,the relationships between FNA-Tg levels and metastatic PTC were investigated.The positive detection rates of FNA-Tg test and traditional cytology test were compared.The macrophage cell and tumor cell in FNA slides were counted,then divided them into 4 groups.The rank sum test was used to analyze the differences of FNA-Tg levels from samples of different cellular components.Results Among the 109 samples,84 samples had positive FNA-Tg results which were consistent with their pathological results（metastatic PTC）.The detect rates of traditional cytology test in simple metastatic PTC and cystic metastatic PTC were 93.9% and 88.6%,respectively.However,the detection rates of FNA-Tg test were 100% in both simple and cystic metastatic PTC.After group clavsification,according to their cellular components,is showed that FNA-Tg levels were not associated with the number of tumor cells.FNA-Tg levels of the group with cystic macrophage were significantly higher than those of the group with no macrophage（U = 367.00,P〈0.01）.Conclusions Tg test by FNA washout fluid can be used as a valuable marker of lymph node metastasls from PTC.FNA-Tg test could improve the deteetiom sensitivity in diagnosing metastatic PTC especially in cystic metastasis.Macrophages seen in traditional cytology test could be indicative of metastasis.