Application of FNA-Tg with CGICA test for the intraoperative diagnosis of lymph node metastasis in papillary thyroid carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

NI Banggao ^1,2 , FEI Yuan ¹ , WU Wenshuang ¹ , WEI Tao ¹ , LI Zhihui ¹ , GONG Rixiang ¹ ,  ZHU Jingqiang ¹ ,  SU Anping ¹

1. Center for Diagnosis and Treatment of Thyroid and Parathyroid Diseases, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Thyroid Surgery, The People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding?author：

ZHU Jingqiang, Email: zjq-wkys@163.com; SU Anping, Email: suanpingping@126.com

Keywords：

papillary thyroid carcinoma; cervical lymph node metastasis; washout fluid; thyroglobulin; colloidal gold immunochromatographic assay

DOI：

10.7507/1007-9424.202111055

Video：

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Objective To investigate the efficacy of fine needle aspiration-thyroglobulin (FNA-Tg) with colloidal gold immunochromatographic assay (CGICA) on the assessment of lymph node metastasis during surgery in papillary thyroid carcinoma (PTC) patients. Methods Seventy-eight patients with PTC who underwent surgery in the Department of Thyroid Surgery of West China Hospital of Sichuan University from August to December 2019 were selected as the research objects, 289 neck lymph node specimens cleaned during the operation were prepared into eluent after lymph node FNA within 10 minutes in vitro, and then the FNA-Tg level was detected rapidly and quantitatively by CGICA. The specimen of washout fluid was labeled and sent to the laboratory for FNA-Tg detection by Roche electrochemiluminescence immunoassay. The lymph nodes in the whole group were divided into central region group and lateral cervical region group according to their location. According to the long diameter of lymph nodes, they were divided into <5 mm group, 5–10 mm group and >10 mm group. With postoperative pathological report as the gold standard, the receiver operating characteristic (ROC) curve of the whole group of data subjects was drawn, and the area under curve (AUC) was compared to calculate the best cut-off value of FNA-Tg in diagnosing PTC lymph node metastasis. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of FNA-Tg CGICA method and Roche method in the whole group and different subgroups were compared. The data of 55 lymph nodes detected by FNA-Tg CGICA method and rapid frozen pathology were collected, and the diagnostic efficacy indexes of CGICA method and rapid frozen pathology in the diagnosis of lymph node metastasis were compared. Results The ROC curves AUC of FNA-Tg detected by CGICA method and Roche method was 0.850 and 0.883, respectively, the difference was not statistically significant (Z=1.011, P>0.05). The sensitivity was 77.7% and 79.6% respectively (χ²=0.05, P>0.05), specificity was 84.9% and 93.5% respectively (χ²=7.50, P<0.05). Using McNemar test, there was no significant difference in the diagnostic results between the CGICA method and Roche method of FNA-Tg in the whole group (P>0.05). The diagnostic efficacy of FNA-Tg CGICA method was better in the lateral cervical region group than that in the central region group, and the diagnostic efficacy of the group with the long diameter of lymph nodes >10 mm was better than those of the groups with the long diameter of lymph nodes <5 mm and 5–10 mm. There was no significant difference in diagnostic results between FNA-Tg CGICA method and rapid frozen pathology (P>0.05). Conclusions The FNA-Tg CGICA method has high value in diagnosing PTC cervical lymph node metastasis, and has the characteristics of rapidity and convenience. The diagnostic efficiency is similar to that of Roche method.

Citation： NI Banggao, FEI Yuan, WU Wenshuang, WEI Tao, LI Zhihui, GONG Rixiang, ZHU Jingqiang, SU Anping. Application of FNA-Tg with CGICA test for the intraoperative diagnosis of lymph node metastasis in papillary thyroid carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(5): 641-647. doi: 10.7507/1007-9424.202111055 Copy

1.	Pacini F, Fugazzola L, Lippi F, et al. Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab, 1992, 74(6): 1401-1404.
2.	Frasoldati A, Pesenti M, Gallo M, et al. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer, 2003, 97(1): 90-96.
3.	Uruno T, Miyauchi A, Shimizu K, et al. Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg, 2005, 29(4): 483-485.
4.	Jeon MJ, Park JW, Han JM, et al. Serum antithyroglobulin antibodies interfere with thyroglobulin detection in fine-needle aspirates of metastatic neck nodes in papillary thyroid carcinoma. J Clin Endocrinol Metab, 2013, 98(1): 153-160.
5.	Lee JH, Lee HC, Yi HW, et al. Influence of thyroid gland status on the thyroglobulin cutoff level in washout fluid from cervical lymph nodes of patients with recurrent/metastatic papillary thyroid cancer. Head Neck, 2016, 38 Suppl 1: E1705-E1712. doi: 10.1002/hed.24305.
6.	Duval MADS, Zanella AB, Cristo AP, et al. Impact of serum TSH and anti-thyroglobulin antibody levels on lymph node fine-needle aspiration thyroglobulin measurements in differentiated thyroid cancer patients. Eur Thyroid J, 2017, 6(6): 292-297.
7.	Zhang X, Howell JM, Huang Y. Cervical lymph node fine-needle aspiration and needle-wash thyroglobulin reflex test for papillary thyroid carcinoma. Endocr Pathol, 2018, 29(4): 346-350.
8.	Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol, 2006, 154(6): 787-803.
9.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
10.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
11.	潘先均, 胡代星, 蘇新良. 頸部中央區淋巴結清掃及術中冰凍病理檢查在甲狀腺微小乳頭狀癌治療中的臨床價值. 上海交通大學學報(醫學版), 2018, 38(2): 180-183.
12.	Boutin P, Bozorg Grayeli A, Terrada C, et al. Results of fine needle aspiration biopsy, frozen section diagnosis and definite histological results in thyroid pathology. Report of 163 case. Rev Laryngol Otol Rhinol (Bord), 2003, 124(1): 59-63.
13.	Nayanar SK, M AK, I MK, et al. Frozen section evaluation in head and neck oncosurgery: an initial experience in a tertiary cancer center. Turk Patoloji Derg, 2019, 35(1): 46-51.
14.	李飛波, 康青松, 陳贏, 等. 細針穿刺細胞學檢查聯合FNA-Tg測定在診斷甲狀腺乳頭狀癌側頸淋巴結轉移中的價值. 浙江醫學, 2019, 41(11): 1165-1168.
15.	齊淑軼, 鄧蒞霏, 謝梅, 等. FNAC與FNA-Tg測定診斷分化型甲狀腺癌頸淋巴結轉移的比較研究. 實用癌癥雜志, 2019, 34(3): 457-459.
16.	孔繁云, 符尚宏, 何勇. 超聲聯合細針穿刺洗脫液甲狀腺球蛋白診斷乳頭狀甲狀腺癌術后淋巴結轉移的效能. 癌癥進展, 2019, 17(5): 1047-1049.
17.	李維生, 錢林學, 劉玉江. 超聲引導下淋巴結細針穿刺洗脫液球蛋白檢測與細胞學檢查的比較. 中國醫學裝備, 2019, 16(4): 56-58.
18.	汪佳慧, 高力, 壽金朵, 等. 術前細針穿刺洗脫液甲狀腺球蛋白在診斷甲狀腺乳頭狀癌淋巴結轉移中的應用及影響因素. 中國腫瘤臨床, 2018, 45(22): 1142-1146.
19.	周樂, 張廣, 張大奇, 等. 細針穿刺活檢及洗脫液檢測在甲狀腺癌頸淋巴結清掃決策中的應用研究. 中國實用外科雜志, 2017, 37(9): 1142-1146.
20.	Wang YZ, Liu YC, Wang XN, et al. Intraoperative measurement of thyroglobulin in lymph node aspirates for the detection of metastatic papillary thyroid carcinoma. Onco Targets Ther, 2017, 10: 4435-4441.
21.	趙曉偉, 關海霞, 孫輝. 頸部淋巴結細針穿刺針洗脫液甲狀腺球蛋白測定臨床應用進展與困惑. 中國實用內科雜志, 2016, 36(1): 37-40.

1. Pacini F, Fugazzola L, Lippi F, et al. Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab, 1992, 74(6): 1401-1404.
2. Frasoldati A, Pesenti M, Gallo M, et al. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma. Cancer, 2003, 97(1): 90-96.
3. Uruno T, Miyauchi A, Shimizu K, et al. Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg, 2005, 29(4): 483-485.
4. Jeon MJ, Park JW, Han JM, et al. Serum antithyroglobulin antibodies interfere with thyroglobulin detection in fine-needle aspirates of metastatic neck nodes in papillary thyroid carcinoma. J Clin Endocrinol Metab, 2013, 98(1): 153-160.
5. Lee JH, Lee HC, Yi HW, et al. Influence of thyroid gland status on the thyroglobulin cutoff level in washout fluid from cervical lymph nodes of patients with recurrent/metastatic papillary thyroid cancer. Head Neck, 2016, 38 Suppl 1: E1705-E1712. doi: 10.1002/hed.24305.
6. Duval MADS, Zanella AB, Cristo AP, et al. Impact of serum TSH and anti-thyroglobulin antibody levels on lymph node fine-needle aspiration thyroglobulin measurements in differentiated thyroid cancer patients. Eur Thyroid J, 2017, 6(6): 292-297.
7. Zhang X, Howell JM, Huang Y. Cervical lymph node fine-needle aspiration and needle-wash thyroglobulin reflex test for papillary thyroid carcinoma. Endocr Pathol, 2018, 29(4): 346-350.
8. Pacini F, Schlumberger M, Dralle H, et al. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol, 2006, 154(6): 787-803.
9. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11): 1167-1214.
10. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
11. 潘先均, 胡代星, 蘇新良. 頸部中央區淋巴結清掃及術中冰凍病理檢查在甲狀腺微小乳頭狀癌治療中的臨床價值. 上海交通大學學報(醫學版), 2018, 38(2): 180-183.
12. Boutin P, Bozorg Grayeli A, Terrada C, et al. Results of fine needle aspiration biopsy, frozen section diagnosis and definite histological results in thyroid pathology. Report of 163 case. Rev Laryngol Otol Rhinol (Bord), 2003, 124(1): 59-63.
13. Nayanar SK, M AK, I MK, et al. Frozen section evaluation in head and neck oncosurgery: an initial experience in a tertiary cancer center. Turk Patoloji Derg, 2019, 35(1): 46-51.
14. 李飛波, 康青松, 陳贏, 等. 細針穿刺細胞學檢查聯合FNA-Tg測定在診斷甲狀腺乳頭狀癌側頸淋巴結轉移中的價值. 浙江醫學, 2019, 41(11): 1165-1168.
15. 齊淑軼, 鄧蒞霏, 謝梅, 等. FNAC與FNA-Tg測定診斷分化型甲狀腺癌頸淋巴結轉移的比較研究. 實用癌癥雜志, 2019, 34(3): 457-459.
16. 孔繁云, 符尚宏, 何勇. 超聲聯合細針穿刺洗脫液甲狀腺球蛋白診斷乳頭狀甲狀腺癌術后淋巴結轉移的效能. 癌癥進展, 2019, 17(5): 1047-1049.
17. 李維生, 錢林學, 劉玉江. 超聲引導下淋巴結細針穿刺洗脫液球蛋白檢測與細胞學檢查的比較. 中國醫學裝備, 2019, 16(4): 56-58.
18. 汪佳慧, 高力, 壽金朵, 等. 術前細針穿刺洗脫液甲狀腺球蛋白在診斷甲狀腺乳頭狀癌淋巴結轉移中的應用及影響因素. 中國腫瘤臨床, 2018, 45(22): 1142-1146.
19. 周樂, 張廣, 張大奇, 等. 細針穿刺活檢及洗脫液檢測在甲狀腺癌頸淋巴結清掃決策中的應用研究. 中國實用外科雜志, 2017, 37(9): 1142-1146.
20. Wang YZ, Liu YC, Wang XN, et al. Intraoperative measurement of thyroglobulin in lymph node aspirates for the detection of metastatic papillary thyroid carcinoma. Onco Targets Ther, 2017, 10: 4435-4441.
21. 趙曉偉, 關海霞, 孫輝. 頸部淋巴結細針穿刺針洗脫液甲狀腺球蛋白測定臨床應用進展與困惑. 中國實用內科雜志, 2016, 36(1): 37-40.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of FNA-Tg with CGICA test for the intraoperative diagnosis of lymph node metastasis in papillary thyroid carcinoma

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