The effectiveness of the method for determining the level of thyroglobulin in needle washouts of fine-needle aspiration biopsy in the differential diagnosis of metastases of highly differentiated thyroid cancer in the lymph nodes of the neck

Introduction. Thyroid cancer is one of the most common malignant neoplasms of the endocrine system. well-differentiated thyroid cancer constitutes about 90 % of all malignant tumors of the thyroid gland. Despite growing morbidity and high incidence of this pathology, in case of timely diagnosis and treatment well-differentiated thyroid cancer has favorable prognosis.

Aim. using clinical examples, to demonstrate the possibility of thyroglobulin measurement in needle washouts of fineneedle aspiration biopsy in the detection of cervical metastases of highly differentiated thyroid cancer.

Materials and methods. five patients (2 patients with combined oncological pathology, 2 patients with nodes in the thyroid gland, 1 patient after a thyroidectomy) with cervical adenopathy measured the level of thyroglobulin in the wash out fluid of lymph-nodes biopsy using the immunoradiometric method using the commercial kits of the Institute of Isotopes-IRmA (Hungary).

Results. Cervical metastases of highly differentiated thyroid cancer were detected or excluded by the determination of fine-needle aspiration biopsy in patients with non-informational cytological studies. The determination of fineneedle aspiration biopsy is a useful diagnostic method in the differential diagnosis of cervical metastases in patients who have other morphological forms of cancer in addition to well-differentiated thyroid cancer, as well as for the differential diagnosis of cervical adenopathy in patients with a history of highly differentiated thyroid cancer.

Conclusion. Determination of thyroglobulin level in puncture needle washout is a simple and useful diagnostic method for differential diagnosis of metastases in lymph nodes of the neck in patients with several morphological forms of malignant tumors.

1. Dal Maso L., Tavilla A., Pacini F. et al. Survival of 86,690 patients with thyroid cancer: a population-based study in 29 European countries from EUROCARE-5. Eur J Cancer 2017;77:140–52. DOI: 10.1016/j.ejca.2017.02.023

2. Malignant neoplasms in Russia in 2015 (morbidity and mortality). Edited by A.D. Kaprin, V.V. Starinsky. Moscow: P.A. Herzen Moscow State Medical Research Institute – branch of the Federal State Budgetary Institution “NMIC of Radiology” of the Ministry of Health of Russia, 2017. Pp. 33, 151. (In Russ.).

3. Haugen B.R., Alexander E.K., Bible K.C. et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26(1):1–133. DOI: 10.1089/thy.2015.0020

4. Zuraeva Z.T., Nikankina L.V., Kolesnikova G.S. et al. Determination of thyroglobulin in a puncture needle flush in the differential diagnosis of cervical lymphadenopathy in patients with highly differentiated thyroid cancer. Endokrinnaya hirurgiya = Endocrine Surgery 2019;13(1):17–25. (In Russ.). DOI: https://doi.org/10.14341/serg9824

5. Beltsevich D.G., Vanushko V.E., Rumyantsev P.O. et al. Russian clinical guidelines for the diagnosis and treatment of highly differentiated thyroid cancer in adults. Endokrinnaya hirurgiya = Endocrine Surgery 2017;11(1):6–27. (In Russ.). DOI: 10.14341/serg20171627

6. Chai Y.J., Suh H., Yi J.W. et al. Factors associated with the sensitivity of fineneedle aspiration cytology for the diagnosis of follicular variant papillary thyroid carcinoma. Head Neck 2016;38(1):E1467–71. DOI: https://doi.org/10.1002/hed.24261

7. Johnson N.A., Tublin M.E. Postoperative surveillance of differentiated thyroid carcinoma: rationale, techniques, and controversies. Radiolog 2008;249(2):429–44. DOI: 10.1148/radiol.2492071313

8. Pacini F., Fugazzola L., Lippi F. et al. Detection of thyroglobulin in fine needle aspirates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab 1992;74(6):1401–4. DOI: 10.1210/jcem.74.6.1592886

9. Cooper S.D., Doherty G.M., Haugen B.R. et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009;19(11):1167–214. DOI: 10.1089/thy.2009.0110

10. Stack B.C., Ferris R.L., Goldenberg D. et al. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 2012;22(5):501–8. DOI: 10.1089/thy.2011.0312

11. Leenhardt L., Erdogan M.F., Hegedus L. et al. 2013 European Thyroid association guidelines for cervical ultrasound scan and ultrasound-guided techniques in the postoperative management of patients with thyroid cancer. Eur Thyroid J 2013;2(3):147–59. DOI: 10.1159/000354537

12. Torres M., Neto S., Rosas R. et al. Thyroglobulin in the washout fluid of lymph-node biopsy: What is its role in the follow-up of differentiated thyroid carcinoma? Thyroid 2014;24(1):7–18. DOI: 10.1089/thy.2013.0244

13. Baskin H.J. Detection of recurrent papillary thyroid carcinoma by thyroglobulin assessment in the needle washout by fine-needle aspiration of suspicious lymph nodes. Thyroid 2004;14(11):959–63. DOI: 10.1089/thy.2004.14.959

14. Cignarelli M., Ambrosi A., Marino A. et al. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic metastatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003;13(12):1163–7. DOI: 10.1089/10507250360731578

15. Uruno T., Miyauchi A., Shimizu K. et al. Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg 2005;29(4):483–5. DOI: 10.1007/s00268-004-7701-0

16. Jeon S.J., Kim E., Park J.S. et al. Diagnostic benefit of thyroglobulin measurement in fine-needle aspiration for diagnosing metastatic cervical lymph nodes from papillary thyroid cancer: correlations with US features. Korean J Radiol 2009;10(2):106–11. DOI: 10.3348/kjr.2009.10.2.106

17. Sigstad E., Heilo A., Paus E. et al. The usefulness of detecting thyroglobulin in fine-needle aspirates from patients with neck lesions using a sensitive thyroglobulin assay. Diagn Cytopathol 2007;35(12):761–7. DOI: 10.1002/dc.20726

18. Kim D.W., Jeon S.J., Kim C.G. Usefulness of thyroglobulin measurement in needle washouts of fine-needle aspiration biopsy for the diagnosis of cervical lymph node metastases from papillary thyroid cancer before thyroidectomy. Endocrine 2012;42(2):399–403. DOI: 10.1007/s12020-012-9636-9

19. Boi F., Baghino G., Atzeni F. et al. The diagnostic value for differentiated thyroid carcinoma metastases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies. J Clin Endocrinol Metab 2006;91(4):1364–9. DOI: 10.1210/jc.2005-1705

20. Grani G., Fumarola A. Thyroglobulin in lymph node fine-needle aspiration washout: a systematic review and meta-analysis of diagnostic accuracy J Clin Endocrinol Metab 2014;99(6): 1970–82. DOI: 10.1210/jc.2014-1098

21. Frasoldati A., Valcavi R. Challenges in neck ultrasonography: lymphadenopathy and parathyroid glands. Endocr Pract 2004;10(3):261–8. DOI: 10.4158/EP.10.3.261

22. Spencer C.A., Bergoglio L.M., Kazarosyan M. et al. Clinical impact of thyroglobulin (Tg) and Tg autoantibody method differences on the management of patients with differentiated thyroid carcinomas. J Clin Endocrinol Metab 2005;90(10):5566–75. DOI: 10.1210/jc.2005-0671