1 南京医科大学附属南京医院(南京市第一医院)功能检查科，南京 210006
2 南京医科大学附属南京医院(南京市第一医院)核医学科，南京 210006
目的：探讨超声引导下颈部淋巴结细针抽吸洗脱液甲状腺球蛋白(fine needle aspiration of thyroid globulin eluent，FNA-Tg)检测在诊断甲状腺癌转移性淋巴结中的价值及其影响因素。方法：选取可疑甲状腺癌颈部淋巴结转移患者78例(转移组56例，非转移组22例)，术前行常规超声检查、超声引导下细针抽吸细胞学(ultrasound-guided fine needle aspiration cytology，US-FNAC)检测、FNA-Tg检测，以术后病理为金标准计算US-FNAC及FNA-Tg各效能指标，得出FNA-Tg诊断界值；对比两组的超声特征；多因素二元logistic回归分析超声特征与FNA-Tg预测甲状腺癌转移性淋巴结的拟合度及影响，分析血清甲状腺球蛋白(thyroid globulin，Tg)及甲状腺存在状态对FNA-Tg诊断效能的影响。结果：US-FNAC及FNA-Tg(7.515 ng/mL为界值)诊断敏感度、特异度、阳性预测值、ROC曲线下面积分别为82.4%、90.9%、95.8%、0.865，100%、95.5%、100%、0.979。5项超声特征(淋巴结形态、内部高回声、液化、钙化、血流)差异有统计学意义(P<0.05)，与FNA-Tg预测转移性淋巴结拟合度良好(符合率约92.3%)，其中内部高回声及液化是FNA-Tg测值升高的独立危险因素。血清Tg测值及甲状腺存在状态均对FNA-Tg诊断效能无明显影响(P>0.05)。结论：FNA-Tg诊断甲状腺癌转移性淋巴结效能高于US-FNAC，与相关超声特征拟合度良好，且影响因素较少，但不能取代US-FNAC，两者联合诊断效能更佳。
Application of fine needle aspiration assay of thyroglobulin eluent in the diagnosis of metastatic thyroid cancer lymph nodes
CorrespondingAuthor: SHAO Guoqiang
This work was supported by 2019 High-level Health Talents “Six Projects and One Project” Top-ranking Talents Project Fund, China (LGY2019005).
Objective: To investigate the value and influencing factors of ultrasound-guided fine needle aspiration of thyroid globulin eluent (FNA-Tg) in the diagnosis of metastatic thyroid cancer lymph nodes. Methods: A total of 78 patients (56 cases of metastatic group, 22 cases of non-metastatic group) with suspected cervical lymph node were selected. The routine ultrasound examination, ultrasound-guided fine needle aspiration cytology (US-FNAC) detection and FNA-Tg detection were performed before operation. The performance indexes of US-FNAC and FNA-Tg were calculated using postoperative pathology as the gold standard, and the threshold value of FNA-Tg was obtained, and the statistical differences of ultrasonic characteristics between the groups were compared. The fitting degree and influence between ultrasonic characteristics and FNA-Tg predicting metastatic thyroid cancer lymph nodes were analyzed by multivariate binary logistic regression, and the effects of serum thyroid globulin (Tg) and thyroid status on the diagnostic efficacy of FNA-Tg were analyzed. Results: The sensitivity, specificity, positive predictive value and the area under ROC curve of US-FNAC and FNA-Tg (with 7.515 ng/mL as the diagnostic threshold) were 82.4%, 90.9%, 95.8%, 0.865; 100%, 95.5%,100%, 0.979 respectively. There were statistically significant differences (P<0.05) in the five ultrasonographic features (lymph node morphology, internal hyperecho, liquefaction, calcification, and blood flow), which had a good fitting degree with FNA-Tg predicting metastatic lymph nodes (coincidence rate was about 92.3%). Among these features, internal hyperecho and liquefaction are independent risk factors for the increase of FNA-Tg values. Serum Tg measurements and thyroid status had no significant effect on the diagnostic efficacy of FNA-Tg (P>0.05). Conclusion: FNA-Tg is more effective than US-FNAC in the diagnosis of metastatic lymph nodes of thyroid cancer. It has a good fitting degree with related ultrasonic features and few influencing factors. However, US-FNAC cannot be replaced by FNA-Tg, and the combination of them is more effective for diagnosis.
thyroid carcinoma; cervical lymph node; metastasis; thyroid globulin; fine needle