Abstract
Background
The use of thyroglobulin concentration in washout fluid of fine-needle aspiration
(FNA-Tg) is a procedure advocated by international guidelines to diagnose metastatic
LN in papillary thyroid cancer. With the increasing use of active follow-up or lobectomy
alone for low-risk thyroid cancers, the determination of the diagnostic performance
of FNA-Tg in the detection of metastatic PTC when the thyroid is in situ is paramount.
Materials and methods
Prospective study with measurement of Tg in washout fluid obtained from intraoperative
fine needle aspiration (FNA) cytology in order to avoid contamination from thyroid
tissue and rigorously isolated punctured nodes. Receiver-operating characteristic
(ROC) curve and area under the curve (AUC), optimal threshold to discriminate benign
and malignant LN, sensitivity and specificity were provided.
Results: a total of 58 lymph nodes from 32 patients were analyzed. ROC analysis defined
the optimal cutoff values of FNA-Tg at 60 ng/ml for the diagnosis of malignant LNs
in patients with a thyroid in situ. Sensitivity and specificity were 75% (95% confidence
interval 57.89–86.75) and 87.5% (95%CI: 69–95.66), respectively.
Conclusion
Our results support the hypothesis that the Tg-FNA threshold for a safe diagnosis
of LN metastasis in PTC is higher in presence of a thyroid gland in situ. The use
of lower thresholds could result in false positive results and lead to unnecessary
surgery.
Keywords
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Article info
Publication history
Published online: December 16, 2022
Accepted:
December 15,
2022
Received in revised form:
December 4,
2022
Received:
November 11,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
