甲状腺球蛋白在甲状腺乳头状癌^(131)I治疗后侧颈淋巴结复发诊断中的作用

The role of thyroglobulin in diagnosis of lateral cervical lymph node recurrence in papillary thyroid cancer after radioiodione therapy

目的探讨甲状腺球蛋白(thyroglobulin,Tg)在甲状腺乳头状癌(papillarythyroid cancer,PTC)^(131)I治疗后侧颈淋巴结复发诊断中的作用及意义。方法回顾性分析2012年1月至2018年8月在天津医科大学肿瘤医院因侧颈淋巴结复发行手术治疗的PTC患者22例,所有患者首次手术后均行^(131)I治疗。结果患者中位复发时间为30.5(5~86)月。22例患者首次手术后均行^(131)I治疗,中位剂量250mCi(100~700 mCi),131I1治疗1~4次不等。颈部淋巴结复发行手术治疗,清扫淋巴结的中位数为31(8~83)枚,其中20例患者术后病理证实存在淋巴结转移,转移淋巴结的中位数为4(1~19)枚。超声检查诊断准确率为90.9%。再次手术前,抑制性Tg的中位数为1.305(0.10~99.51)μg/L。抑制性Tg的临界值0.2μg/L,其灵敏度特异度分别为80.0%,100%。10例患者中,剌激性Tg的中位数为5.89(0.14~255.80)μg/L。刺激性Tg的临界值2μg/L,其灵敏度、特异度分别为88.9%、100%。结论抑制性和刺激性Tg可监测PTC患者的病情发展,但是Tg不高者,并不能完全排除复发。

Objective To evaluate the role of Tg in diagnosis of lateral cervical lymph node recurrence in papillary thyoid cancer(PTC)after radioactive iodine(RAI)therapy.Methods From Jan 2012 to Aug 2018,22 PTC patients who received RAI therapy after operation were reoperated for lateral cervical lymph node recurrence.The clinical data was retrospectively analyzed.Results The median recurrence time was 30.5(5-86)months.All 22 patients received RAI therapy after the first operation,and the median dose of RAI was 250mCi(100-700 mCi)and the episode of RAI therapy ranged from 1 to 4.All 22 PTC patients underwent neck reoperation,among which 20 cases were identified to have lymph node metastasis.The median number of lymph nodes dissected was 31(8-83)and median number of metastatic lymph nodes was4(1-19).The diagnostic accuracy of ultrasonography in detecting lymph node metastasis was 90.9%.Before reoperation,the median Tg was 1.305(0.10-99.51)μg/L,with the cutoff value of Tg being 0.2μg/L,and its sensitivity and specificity were 80.0%and 100%,respectively.The median stimulated Tg was 5.89(0.14-255.80)μg/L in the 10 patients,with the cutoff value of stimulated Tg of 2μg/L,and its sensitivity and specificity were 88.9%and 100%,respectively.Conclusions The serum Tg level is helpful for monitoring the recurence of PTC,but recurrence cannot be completely ruled out for those with low Tg.