FNA-Tg、Tg对术前甲状腺乳头状癌淋巴结转移的诊断价值及相关性分析  

Diagnostic value and correlation analysis of FNA-Tg and Tg in preoperative lymph node metastasis of papillary thyroid carcinoma

作　　者：杨波[1] 林珍珍 张钱磊 李泽霖 高海霞 王维娜[1] 单美慧[2,3] YANG Bo;LIN Zhenzhen;ZHANG Qianlei;LI Zelin;GAO Haixia;WANG Weina;SHAN Meihui(Department of Pathology,Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830011,China;The Breast and Thyroid Surgery Department,Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830011,China;The Clinical Medical Research Center of Breast and Thyroid Tumor in Xinjiang,Affiliated Tumor Hospital,Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院病理科,乌鲁木齐830011 [2]新疆医科大学附属肿瘤医院乳腺甲状腺外科,乌鲁木齐830011 [3]新疆医科大学附属肿瘤医院、新疆乳腺甲状腺肿瘤临床医学研究中心,乌鲁木齐830011

出　　处：《新疆医科大学学报》2023年第11期1507-1512,共6页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金项目(2021D01C408);新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-202152)。

摘　　要：目的探讨细针穿刺细胞学(fine-needle aspiration cytology,FNAC)检查、穿刺洗脱液甲状腺球蛋白(fine-needle aspiration cytology with needle-wash thyroglobulin,FNA-Tg)测定及甲状腺球蛋白(thyroglobulin,Tg)免疫细胞化学染色在术前甲状腺乳头状癌(papillary thyroid carcinoma,PTC)淋巴结转移诊断中的价值,并分析血清Tg水平和促甲状腺激素(thyroidstimulating hormone,TSH)水平对FNA-Tg诊断PTC淋巴结转移效能的影响。方法选取2022年3月至2023年4月期间,在本院行甲状腺切除合并颈部淋巴结清扫手术的98例患者共164个淋巴结。所有患者术前均行常规血清Tg、TSH测定、超声检查、FNAC检查及FNA-Tg测定,对组织病理学确定转移的33个淋巴结行Tg免疫细胞化学染色。分析FNA-Tg、Tg对FNAC的辅助诊断价值及术前血清Tg、TSH与FNA-Tg的相关性。结果单因素分析提示淋巴结转移组FNA-Tg、血清Tg水平分别高于非转移组(P<0.05),多因素二元逻辑回归分析显示,FNA-Tg是PTC淋巴结转移诊断的影响因素(P<0.001)。FNA-Tg诊断PTC术前淋巴结转移的最佳阈值为98.605 ng/mL。FNA-Tg联合FNAC检测的敏感性、特异性、准确性分别为88.3%、95.1%、90.9%;FNAC、FNA-Tg及联合检测,各诊断方法检测PTC术前淋巴结转移无统计学差异(P>0.05)。FNAC、FNA-Tg、联合检测的准确性、曲线下面积(AUC)分别为85.4%、85.4%、90.9%和0.767、0.714、0.834。Tg免疫细胞化学染色阳性率为100%。血清Tg、TSH水平与FNA-Tg诊断效能呈弱相关。结论根据肿瘤细胞数量,FNA-Tg和/或Tg免疫细胞化学染色可作为FNAC的辅助诊断。FNA-Tg诊断的准确性受血清Tg、TSH水平的影响不明显。Objective To investigate the diagnostic value of fine-needle aspiration cytology(FNAC)with needle-wash thyroglobulin(FNA-Tg)and thyroglobulin immunocytochemical staining for lymph node metastasis of preoperative papillary thyroid carcinoma(PTC)and its influencing factors.Methods A total of 164 suspected metastatic lymph nodes from 98 patients who underwent thyroidectomy and cervical lymphadenectomy were selected in the study.Serum Tg,serum thyroidstimulating hormone(TSH),ultrasonography,FNAC and FNA-Tg results were acquired in all patients.Tg immunocytochemical staining was performed on 33 lymph nodes with metastasis by histopathology.The correlation between preoperative serum Tg,serum TSH and lymph node FNA-Tg level were analyzed.Results Univariate analysis suggested that FNA-Tg and serum Tg levels were higher in lymph node metastasis group than in non-metastasis group(P<0.05),multivariate binary logistic regression analysis showed that FNA-Tg was an influential factor in the diagnosis of PTC lymph node metastasis diagnosis(P<0.001).The optimal threshold value of FNA-Tg was 98.605 ng/mL.The sensitivity,specificity and accuracy of combined detection were 88.3%,95.1%,90.9%,respectively.FNAC,FNA-Tg and combined detection were no significant differences(P>0.05).The accuracy and area under the curve(AUC)of FNAC,FNA-Tg and combined detection were 85.4%,85.4%and 90.9%and 0.767,0.714 and 0.834,respectively.The positive rate of Tg immunocytochemistry was 100%.Serum Tg and TSH levels were weakly correlated with accuracy of FNA-Tg respectively.Conclusions Depending on the number of tumor cells,choosing FNA-Tg and/or Tg immunocytochemistry staining can be used as auxiliary diagnostic of FNAC.The diagnostic accuracy of FNA-Tg was not significantly affected by serum Tg and TSH levels.

关 键 词：甲状腺乳头状癌 淋巴结转移 细针穿刺细胞学 甲状腺球蛋白 

分 类 号：R736.1[医药卫生—肿瘤]