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This version published online on August 7, 2007
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2007-1075
A more recent version of this article appeared on November 1, 2007
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*THYROGLOBULIN
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Serum thyroglobulin, high resolution ultrasound and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases

Christine L.H. Snozek, Eugene P. Chambers, Carl C. Reading, Thomas J. Sebo, J. Woody Sistrunk, Ravinder J. Singh, and Stefan K.G. Grebe*

Departments of Laboratory Medicine and Pathology (C.L.H.S., T.J.S., R.J.S., S.K.G.G.), Medicine, Division of Endocrinology (S.K.G.G.), and Diagnostic Radiology (C.C.R.), Mayo Clinic, Rochester, MN 55905; Department of Surgery, Division of Surgical Oncology and Endocrine Surgery (E.P.C.), Vanderbilt-Ingram Cancer Center, Nashville, TN, 37232; and Jackson Thyroid and Endocrine Clinic, P.L.L.C. (J.W.S.), Jackson, MS, 39216

* To whom correspondence should be addressed. E-mail: grebe.stefan{at}mayo.edu.

Context: Clinically enlarged cervical lymph nodes in patients with a history of thyroid cancer are usually assessed by fine-needle aspiration biopsy (FNAB) followed by cytology with or without tissue core. Thyroglobulin (Tg) is frequently elevated in malignant FNAB needle-wash specimens and may possibly augment or replace cytology. Furthermore, the combination of undetectable serum Tg and an innocuous ultrasound might altogether obviate the need for biopsy.

Objectives: (1) Determine an appropriate diagnostic cutoff for Tg levels in FNAB; (2) assess the diagnostic performance at this cutoff; and (3) compare serum Tg and FNAB needle-wash Tg levels to determine if serum Tg levels predict positive Tg FNAB.

Design: Retrospective study of 122 FNAB samples in 88 athyrotic thyroid cancer patients.

Results: Fifty of 52 (96.2%) non-malignant FNAB samples had Tg ≤1 ng/mL. All 70 malignant FNAB had Tg >1 ng/mL. Of 103 specimens with diagnostic cytology, 5 (4.9%) had discordant Tg results; in 4 of these FNAB Tg was concordant with the final diagnosis. Eighteen of 19 (94.7%) FNAB with non-diagnostic (N=16) or absent (N=3) cytology were correctly classified by FNAB needle-wash Tg. Undetectable (<0.1 ng/mL) serum Tg was associated with a negative diagnosis in 21 of 23 (91.7%) biopsies; the 2 cancer-positives were both serum Tg-autoantibody (TgAb) positive and classified as suspicious by ultrasonography.

Conclusions: Nodal FNAB needle-wash Tg measurements complement cytology in thyroid cancer follow-up, and might substitute for it. The combination of unremarkable ultrasonography and an undetectable serum Tg in TgAb-negative patients might obviate the need for FNAB.
Key words: Thyroid cancer • thyroglobulin • cancer monitoring • fine needle aspiration biopsy • cytology




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 Eur J EndocrinolHome page
A.-L. Borel, R. Boizel, P. Faure, G. Barbe, J. Boutonnat, N. Sturm, D. Seigneurin, I. Bricault, J.-P. Caravel, P. Chaffanjon, et al.
Significance of low levels of thyroglobulin in fine needle aspirates from cervical lymph nodes of patients with a history of differentiated thyroid cancer
Eur. J. Endocrinol., May 1, 2008; 158(5): 691 - 698.
[Abstract] [Full Text] [PDF]

eLetters:

Read all eLetters

Lymph node thyroglobulin is a quantity, not a concentration
Olivier CHABRE, et al.
JCEM Online, 13 Feb 2008 [Full text]
Response to Chabre et al's letter: Lymph node thyroglobulin is a quantity, not a concentration
Stefan Grebe
JCEM Online, 28 Feb 2008 [Full text]

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