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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Editorial Board Member: Gillery, Philippe / Kazmierczak, Steven / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Whitfield, John B.

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Thyroglobulin measurement in fine-needle aspirates of lymph nodes in patients with differentiated thyroid cancer: a simple definition of the threshold value, with emphasis on potential pitfalls of the method

Claire Bournaud1, a / Anne Charrié2, a / Cécile Nozières1 / Karim Chikh2 / Véronique Lapras3 / Marie-Laure Denier4 / Christian Paulin5 / Myriam Decaussin-Petrucci5 / Jean-Louis Peix6 / Jean-Christophe Lifante6 / Catherine Cornu7 / Céline Giraud8 / Jacques Orgiazzi9 / Françoise Borson-Chazot1

1Hospices Civils de Lyon, Service Médecine Nucléaire, Groupement Hospitalier Est, Lyon, France

2Département de Biologie, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France

3Hospices Civils de Lyon, Service de Radiologie, Hôpital Hôtel-Dieu, Lyon, France

4Hospices Civils de Lyon, Service de Radiologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France

5Département d'Anatomie Pathologique, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France

6Hospices Civils de Lyon, Service de Chirurgie Générale, Centre Hospitalier Lyon Sud, Pierre-Bénite, France

7INSERM, CIC201, Lyon, France; CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon, UMR 5558, Lyon, France

8INSERM, CIC201, Lyon, France

9Hospices Civils de Lyon, Service d'Endocrinologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France

aC. Bournaud and A. Charrie contributed equally to this work.

Corresponding author: Dr. Anne Charrié, Centre de Biologie, Centre Hospitalier Lyon Sud, 165, chemin du Grand Revoyet, F-69495 Pierre Bénite Cedex, France Phone: +33 478 86 21 69, Fax: +33 478 86 66 54,

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 48, Issue 8, Pages 1171–1177, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2010.220, May 2010

Publication History

Received:
2009-09-24
Accepted:
2010-02-05
Published Online:
2010-05-04

Abstract

Background: Thyroglobulin measurements in fine-needle aspirate (FNA-Tg) is an accurate method for the diagnosis of lymph node metastasis in differentiated thyroid carcinoma. The goal of this study is to determine the most appropriate diagnostic threshold value for FNA-Tg.

Methods: Ultrasound-guided fine-needle aspiration-cytology (FNA-C) and FNA-Tg were performed on suspicious lymph nodes in 114 consecutive patients with thyroid cancer prior to thyroidectomy (n=13) or during follow-up (n=93), and in 16 control subjects. Functional sensitivity of the thyroglobulin assay was 0.7 ng/mL. Sensitivity and specificity of FNA-Tg and FNA-C were determined for different cut-off values within a range of 0.69–1.34 nanogram/punction (ng/p) using receiver operating characteristic curve analysis.

Results: The FNA-Tg cut-off value of 0.93 ng/p offers the best diagnostic performances: 94.2% sensitivity, 97.8% specificity. FNA-C showed 100% specificity in diagnostic samples, but low sensitivity of 71% due primarily to inadequate samples. Combining FNA-C and FNA-Tg resulted in 98% sensitivity and 100% specificity.

Conclusions: A unique threshold of 0.93 ng/p gives high sensitivity and specificity, even in non-thyroidectomized patients. However, since false negative results may be observed in poorly differentiated thyroid cancer, FNA-C should remain combined to FNA-Tg.

Clin Chem Lab Med 2010;48:1171–7.

Keywords: fine-needle aspiration; lymph node; thyroglobulin; thyroid cancer

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