术前细针穿刺洗脱液甲状腺球蛋白在诊断甲状腺乳头状癌淋巴结转移中的应用及影响因素  

Role of preoperative washout fluid thyroglobulin from fine-needle aspirates in detecting lymph node metastases of papillary thyroid carcinoma and its influential factors

作　　者：汪佳慧 高力[1] 寿金朵[2] 蒋贤锋[1] 张慕蕊[3] 周卫萍[2] Jiahui Wang;Li Gao;Jinduo Shou;Xianfeng Jiang;Murui Zhang;Weiping Zhou(Department of Head and Neck Surgery, Instruction Center of Zhejiang Province for Prevention & Treatment of Thyroid Disease, Institute of Minimally Invasive Surgery of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou 310016, China;Department of Ultrasound, School of Medicine, Zhejiang University, Hangzhou 310016, China;Department of Pathology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China)

机构地区：[1]浙江大学医学院附属邵逸夫医院头颈外科,浙江省甲状腺诊治技术指导中心,浙江大学微创外科研究所,杭州市310016 [2]浙江大学医学院附属邵逸夫医院超声科,杭州市310016 [3]浙江大学医学院附属邵逸夫医院病理科,杭州市310016

出　　处：《中国肿瘤临床》2018年第22期1142-1146,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨术前细针穿刺洗脱液甲状腺球蛋白(washout fluid thyroglobulin in fine-needle aspiration,FNA-Tg)在诊断甲状腺乳头状癌(papillary thyroid carcinoma,PTC)淋巴结转移中的应用及影响因素。方法:回顾性分析2015年9月至2016年12月浙江大学医学院附属邵逸夫医院131例经病理证实为PTC且术前进行可疑淋巴结FNA及FNA-Tg测定的患者资料,以细针穿刺、手术病理或随访结果为"金标准",绘制ROC曲线计算FNA-Tg最佳诊断阈值,比较各检测方法(FNA、FNA-Tg和FNA+FNA-Tg)的诊断效能。进一步分析淋巴结解剖学分区、相关实验室指标对FNA-Tg诊断准确性的影响。结果:本研究中FNA-Tg的最佳诊断阈值为1.295 ng/mL。两者联合法诊断效能最佳,灵敏度及特异度分别达96.4%和99.2%。FNA-Tg在诊断侧颈淋巴结转移准确性较好,血清甲状腺球蛋白(serum Tg,sTg)是FNA-Tg>1.295 ng/mL的独立预测因子,OR值为1.018。结论:FNA-Tg是术前诊断PTC淋巴结转移,尤其是侧颈淋巴结转移的重要方法。1.295 ng/mL可以成为最佳诊断阈值的参考值之一,但sTg较高时,FNA-Tg的解读需要谨慎。Objective: To investigate the diagnostic value and influential factors of washout fluid thyroglobulin collected during fineneedle aspiration(FNA-Tg) in detecting lymph node metastases of papillary thyroid carcinoma(PTC) before thyroidectomy. Methods:We retrospectively analyzed 131 patients diagnosed with PTC based on histopathology. They presented with suspicious enlarged cervical lymph nodes and underwent high-frequency ultrasound-guided FNA before the surgery. FNA and FNA-Tg were performed simultaneously. All the related data were collected. In order to obtain the best cut-off value, the FNA-Tg receiver-operating characteristic curve was generated. The cytopathology and postoperative pathologic results, as well as the ultrasound images during the follow-up,were considered the gold standard. The diagnostic performance of each method(FNA, FNA-Tg, and FNA+FNA-Tg) were compared. Additionally, some suspicious influential factors such as the anatomical location of lymph nodes and associated laboratory indexes were also analyzed for the diagnostic accuracy of FNA-Tg. Results: The best cut-off value of FNA-Tg in our study was 1.295 ng/mL. The diagnostic performance of the combined method was the best when compared with other methods, with a sensitivity of 96.4% and specificity of 99.2%. Additionally, FNA-Tg was much more accurate when used in diagnosis of lateral cervical lymph nodes. Among all the associated laboratory indexes, the level of serum Tg(sTg) was an independent predictive factor for an FNA-Tg level above 1.295 ng/mL(odds ratio=1.018). Conclusions: FNA-Tg is a useful tool in the identification of metastatic cervical lymph nodes preoperatively, especially for lateral cervical lymph nodes. In addition, 1.295 ng/mL could be one of the reference standards of the FNA-Tg cut-off value.When the sTg level is high, we should interpret the FNA-Tg results cautiously.

关 键 词：甲状腺乳头状癌 淋巴结转移 细针穿刺洗脱液甲状腺球蛋白 

分 类 号：R736.1[医药卫生—肿瘤]