细针穿刺细胞学检查联合FNA-Tg测定在诊断甲状腺乳头状癌侧颈淋巴结转移中的价值

Fine-needle aspiration cytology with thyroglobulin measurement in diagnosis of lateral neck lymph node metastasis in papillary thyroid carcinoma

目的探讨超声引导下细针穿刺细胞学检查(FNAC)联合洗脱液甲状腺球蛋白(FNA-Tg)检测在甲状腺乳头状癌(PTC)侧颈淋巴结转移中的诊断价值。方法回顾性分析PTC患者51例共77枚侧颈区可疑肿大淋巴结,行FNAC和FNA-Tg检测。分别选取FNA-Tg>血清-Tg和FNA-Tg>1ng/ml为阳性标准值;分析FNA-Tg阳性标准值的选择和FNAC联合FNA-Tg的诊断价值。结果60枚转移淋巴结内的FNA-Tg值显著高于17枚非转移淋巴结(148.12 vs 0.15,P<0.01)。FNA-Tg>血清-Tg的诊断灵敏度和特异度与FNA-Tg>1ng/ml相似(灵敏度:91.6%vs 98.3%,P>0.05;特异度:88.2%vs 70.6%,P>0.05)。FNAC联合FNA-Tg较单独FNAC的诊断灵敏度高(FAN-Tg>1ng/ml:98.3%vs 83.3%,P<0.01;FNA-Tg>血清-Tg:96.7%vs 83.3%,P<0.05)。结论在阳性标准值选择上,FNA-Tg>血清-Tg和FNA-Tg>1ng/ml的诊断效能相似。FNAC联合FNA-Tg对PTC侧颈淋巴结转移的诊断效能要优于单纯的FNAC。

Objective To assess the value of ultrasound guided fine-needle aspiration cytology(FNAC)and thyroglobulin measurement(FNA-Tg)in diagnosis of lateral neck node metastasis in patients with papillary thyroid carcinoma(PTC).Methods Fifty one PTC patients with 77 suspected metastatic lateral lymph nodes underwent FANC and FNA-Tg.FNA-Tg/serum-Tg>1 and FNA-Tg>1 ng/ml were taken as the cutoff value for lymph node metastasis.The values of FNAC and FNA-Tg combined with FNAC in the diagnosis of metastatic lymph nodes were compared with different cutoff values of FNA-Tg.Results The median FNA-Tg was significantly higher in 60 malignant lymph nodes than that in 17 benign lymph nodes(148.12 vs.0.15,P<0.01).There were no significant differences in sensitivity(91.6%vs.98.3%,P>0.05)and specificity(88.2%vs.70.6%,P>0.05)between FNA-Tg>serum-Tg and FNA-Tg>1 ng/ml.The sensitivity of FNAC combined with FNA-Tg was significantly higher than that of FANC alone(for FNA-Tg>serum-Tg:96.7%vs.83.3%,P<0.05;for FAN-Tg>1 ng/ml:98.3%vs.83.3%,P<0.01).Conclusion The values of FNA-Tg>serum-Tg and FNA-Tg>1 ng/ml in diagnosis of lateral neck lymph node metastasis are similar.The combination of FNAC with FNA-Tg is superior to FANC alone in diagnosis of lateral neck lymph node metastasis in patient with PTC.