穿刺洗脱液甲状腺球蛋白测定在诊断甲状腺乳头状癌转移淋巴结中的应用

Application of thyroglobulin measurement in fine-needle aspiration for detecting lymph node metastasis in papillary thyroid carcinoma

目的评价细针穿刺洗脱液甲状腺球蛋白测定(thyroglobulin measurement with fine-needle aspiration,FNA-Tg)在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)淋巴结转移中的诊断价值,并分析FNA-Tg在不同影响因素下的准确性。方法选取我院行甲状腺全切+颈淋巴结清扫术的138例患者共154个淋巴结。所有患者均行术前常规超声检查、细针穿刺细胞学检查(fine-needle aspiration cytology,FNAC)和FNA-Tg测定。比较FNAC、FNA-Tg及二者联合对PTC转移淋巴结的诊断效能。分析淋巴结大小、淋巴结囊性结构和血清甲状腺球蛋白抗体(thyroglobulin antibody,TgAb)水平对FNAC和FNA-Tg准确性的影响。结果FNAC、FNA-Tg及二者联合诊断PTC转移淋巴结的敏感性分别为79.5%、95.5%、97.7%,特异性分别为100%、93.9%、100%。淋巴结大小、淋巴结囊性结构对FNAC的准确性有影响(均P<0.05),对FNA-Tg的准确性无影响(P=0.42,0.67)。血清TgAb水平对FNAC和FNA-Tg的准确性均无影响(P=0.88,0.34)。结论FNA-Tg诊断PTC转移淋巴结的准确性较高,且不受淋巴结大小、淋巴结囊性结构和血清TgAb水平的影响,与FNAC联合后可显著提高诊断的敏感性,在PTC转移淋巴结的诊断中具有重要的意义。

Objective To explore the diagnostic value of thyroglobulin measurement with fine-needle aspiration (FNA-Tg) in detecting papillary thyroid carcinoma(PTC) metastatic lymph nodes, and analyze the impact of different factors on the diagnostic accuracy of FNA-Tg. Methods One hundred and fifty-four lymph nodes from 138 patients who underwent total thyroidectomy and cervical lymphadenectomy were enrolled. Ultrasonography, fine needle aspiration cytology (FNAC) and FNA-Tg results were acquired in all patients. The diagnostic value of FNAC, FNA-Tg and the combination of the two methods were compared in suspicious PTC metastatic lymph nodes. The influence of lymph nodes size, lymph nodes cystic change and serum thyroglobulin antibody(TgAb) on the accuracy of FNAC and FNA-Tg were analyzed. Results The sensitivities of FNAC, FNA-Tg, and the combination of the two methods in the diagnosis were 79.5%, 95.5% and 97.7%, respectively. The specificities were 100%, 93.9% and 100%, respectively. The size and cystic change of lymph nodes had effects on the accuracy of FNAC(P<0.05), while they had no effect on the accuracy of FNA-Tg (P=0.42, 0.67). The serum TgAb level had no influence on the accuracy of FNAC and FNA-Tg (P=0.88, 0.34). Conclusions FNA-Tg is sensitive to metastatic lymph nodes in PTC which not affected by the lymph nodes size, the lymph nodes cystic change and serum TgAb level. Application of FNA-Tg with FNAC can improve the sensitivity of diagnosis, which is important in the diagnosis of PTC metastatic lymph nodes.