穿刺洗脱液甲状腺球蛋白浓度对儿童甲状腺乳头状癌颈侧区淋巴结转移的诊断价值

Application of determination of thyroglobulin in puncture eluate in the diagnosis of lateral cervical lymph node metastasis of papillary thyroid carcinoma in children

目的:探讨超声引导下颈侧区淋巴结穿刺(FNA)洗脱液中甲状腺球蛋白(FNA-Tg)浓度对儿童甲状腺乳头状癌(PTC)颈侧区淋巴结转移的诊断价值。方法:对33例年龄在18岁及以下的PTC伴颈侧区淋巴结肿大患者的48枚颈部侧区淋巴结行FNA细胞学检查及FNA-Tg浓度测定。以术后病理为金标准,绘制FNA-Tg浓度诊断颈侧区淋巴结转移的ROC曲线。结果:术后病理证实淋巴结转移41枚,未转移7枚。FNA细胞学诊断颈侧区淋巴结转移的灵敏度为82.93%,特异度为57.14%,约登指数为0.401。根据FNA-Tg浓度诊断颈侧区淋巴结转移的ROC曲线,确定诊断界值为55.1μg/L,此时灵敏度为92.68%,特异度为85.71%,约登指数为0.784。FNA细胞学联合FNA-Tg(55.1μg/L)诊断的灵敏度为97.56%,特异度为57.14%,约登指数为0.547。联合法灵敏度高于FNA细胞学(χ2=4.170,P=0.041),但与FNA-Tg比较差异无统计学意义(χ2=0.500,P=0.480)。结论:FNA-Tg诊断儿童颈侧区淋巴结转移的界值可选55.1μg/L。FNA细胞学联合FNA-Tg可提高儿童PTC患者术前颈侧区淋巴结转移诊断的灵敏度。

Aim:To evaluate the diagnostic value of the thyroglobulin concentration in fine-needle aspiration(FNA-Tg)for lateral cervical lymph node metastasis in children with papillary thyroid carcinoma(PTC).Methods:Forty-eight lateral cervical lymph nodes from 33 PTC patients aged 18 years and under with enlarged lateral cervical lymph nodes were examined by FNA cytology and FNA-Tg concentration determination.Postoperative pathologic results were taken as the gold standard,and ROC curve of FNA-Tg concentration for diagnosis of lateral cervical lymph nodes metastasis was drawn.Results:Postoperative pathologic results confirmed metastasis in 41/48 lymph nodes.The sensitivity and specificity of FNA cytology were 82.93%and 57.14%,and youden index was 0.401.With the diagnostic cutoff value of 55.1μg/L,the sensitivity and specificity of FNA-Tg concentration were 92.68%and 85.71%,and youden index was 0.784.The sensitivity and specificity of FNA cytology combined with FNA-Tg(55.1μg/L)were 97.56%and 57.14%,and youden index was 0.547.The sensitivity of combined method was higher than that of FNA cytology(P=0.041),but the difference between combined method and FNA-Tg was not significant(P=0.480).Conclusion:The cutoff value of FNA-Tg in diagnosis of lateral cervical lymph nodes metastasis in children with PCT is 55.1μg/L.FNA cytology combined with FNA-Tg can improve the sensitivity of diagnosis of lateral cervical lymph node metastasis in children with PTC.