Utility of Thyroglobulin Measurements in Fine-needle Aspirates of Space Occupying Lesions in the Thyroid Bed after Thyroid Cancer Operations.
ABSTRACT Background:Ultrasound(US),and sometimes cytology,cannot differentiate between recurrent or persistent thyroid cancer and benign forms of space occupying lesions(SOLs) in the thyroid bed, including unsuspected thyroid remnants,that are noted several months to years after thyroidectomy(Tx) for thyroid cancer. The purpose of the present study was to evaluate the hypothesis that measurement of thyroglobulin(Tg) in fine needle aspirates from these lesions might help differentiate between benign and malignant SOLs in the thyroid bed. Methods:We studied 47 lesions in the thyroid bed from 43 patients who,8 to 240 months previously,had 43 Txs for thyroid cancer. Eleven patients had a lobectomy and 32 patients had a total Tx. Also,some patient had radioactive iodine(RAI) ablation after their thyroid surgery and some did not. 'Recurrence' was defined as the SOL,which was confirmed by cytological or histopathological results. 'Benign SOL' was defined as a focal lesion,that was benign or nondiagnostic result on cytology and for which there was no 131I uptake on whole body scintigraphy with both negative serum Tg and Tg-Ab. Diagnostic performances of FNA cytology (FNAC),FNA-Tg and combining FNAC with FNA-Tg level were assessed for detection of malignant SOL. The diagnostic performance of FNA-Tg was assessed using three threshold values of 1ng/mL,10ng/mL and FNA-Tg/serum-Tg ratio of 1.0. Results:FNA-Tg level and combining FNA-Tg levels with FNAC had higher sensitivities(100 % in all three threshold values ) and diagnostic accuracies (91.5 to 95.7%) than FNAC alone(sensitivity of 85.3%,accuracy of 89.4%) in all threshold values. In both the RAI ablation and non-RAI ablation groups,the FNA-Tg levels and combining the FNA-Tg levels with FNAC had a higher sensitivity and diagnostic accuracy than FNAC alone with threshold values of 10ng/mL and FNA-Tg/serum-Tg of 1.0. The non-RAI ablation group did not have a different diagnostic accuracy than the RAI ablation group in all threshold values (P>0.05). FNA-Tg level showed NPV of 100% in all threshold values, both in RAI ablation and non-RAI ablation groups. Conclusions:Measurement of Tg levels in the FNA of SOLs in the thyroid bed can be helpful in diagnosing tumor recurrence, because a negative FNA-Tg level lower than threshold value may has the added value of suggesting a benign lesion rather than tumor recurrence .