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Submitted on July 29, 2005
Accepted on January 17, 2006
Endocrinology Department of Medical Sciences "M. Aresu" and Department of Cytomorphology San Giovanni di Dio Hospital, University of Cagliari, Cagliari, Italy
* To whom correspondence should be addressed. E-mail: mariotti{at}pacs.unica.it.
Objective: Serum thyroglobulin (Tg) is the marker of differentiated thyroid carcinoma (DTC) after total thyroidectomy, but its value is limited by the interference of anti-Tg antibodies (TgAb). Detection of Tg in fine-needle aspiration biopsy (Tg-FNAB) wash-out fluid is used to identify neck DTC recurrences/metastases, but the interference of serum TgAb in this procedure is unknown.
Subjects and methods: Seventy-three patients (41 after surgery for thyroid cancer and 32 with thyroid nodules) evaluated for suspicious cervical lymph nodes were retrospectively reviewed. Tg was assayed by IRMA or chemiluminescent assay in ultrasound-guided FNAB used for cytology. Serum TgAb were detected by passive agglutination or chemiluminescent assay. On the basis of preliminary data obtained in lymphoadenitis, Tg-FNAB >36 ng/ml and >1.7 ng/ml (in presence or absence of thyroid gland, respectively) was considered as indicative of metastasis.
Results: In 51 TgAb-negative patients, Tg-FNAB was positive in 15 (12 with malignant and 3 with not-diagnostic cytology), all with histologically confirmed DTC metastases. Of the remaining 36 patients with negative Tg-FNAB, 30 had not-suspicious and 6 suspicious cytology. Histology of the latter showed 4 undifferentiated thyroid cancer metastases and 2 lymphoadenitis. In 22 TgAb-positive patients, Tg-FNAB was positive in 14 (12 with malignant and 2 with not-diagnostic cytology), all with histologically confirmed DTC metastases.
Conclusions: Clinical performance of Tg-FNAB appears to be not substantially affected by TgAb and this procedure remains superior to cytology in the identification of DTC neck metastases. However, cytology should always be performed, since, irrespectively form TgAb, Tg is undetectable in FNAB from undifferentiated metastases.
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