Clinical Outcome of Fine Needle Aspiration Cytology and Washout Thyroglobulin in Suspicious Lymph Nodes in Differentiated Thyroid Carcinoma: Discordant Results in Real-World Practice
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Background and Objectives: Fine needle aspiration cytology (FNAC) combined with washout thyroglobulin (Tg)measurement is the gold standard for the evaluation of metastatic lymph nodes (LNs) in thyroid cancer. However,few studies have assessed the clinical outcomes of discordant results between FNAC and washout Tg based onsurgery status and follow-up imaging in real-world practice. Materials and Methods: A total of 707 LNs in 512patients who underwent FNAC and washout Tg measurements from 2015 to 2017 were analyzed. The final LNoutcomes were confirmed through postoperative histology, or through metastatic FNAC findings combined withhigh washout Tg level, follow-up imaging studies, or repeat FNA, if LNs were not dissected. Results: The cut-offvalues of washout Tg for indicating LN metastasis in preoperative and postoperative LNs were 9.6 ng/mL and2.1 ng/mL. The diagnostic accuracy was improved by applying washout Tg according to surgery status and theresults of discordant rate was reduced, Discordant between results of FNAC with washout Tg and final outcomewere 9.2% (27/295) of preoperative LNs and 8.7% (36/412) of postoperative LNs. Due to inconclusive results,unnecessary neck dissection can occur in 13.9% (36/259 dissected cases). Conclusion: To improve diagnosticaccuracy, cut-off values of washout Tg should be applied depending on surgery status. New biomarkers in washoutfluid is necessary to resolve discordant findings.
Abstract
Background and Objectives: Fine needle aspiration cytology (FNAC) combined with washout thyroglobulin (Tg)measurement is the gold standard for the evaluation of metastatic lymph nodes (LNs) in thyroid cancer. However,few studies have assessed the clinical outcomes of discordant results between FNAC and washout Tg based onsurgery status and follow-up imaging in real-world practice. Materials and Methods: A total of 707 LNs in 512patients who underwent FNAC and washout Tg measurements from 2015 to 2017 were analyzed. The final LNoutcomes were confirmed through postoperative histology, or through metastatic FNAC findings combined withhigh washout Tg level, follow-up imaging studies, or repeat FNA, if LNs were not dissected. Results: The cut-offvalues of washout Tg for indicating LN metastasis in preoperative and postoperative LNs were 9.6 ng/mL and2.1 ng/mL. The diagnostic accuracy was improved by applying washout Tg according to surgery status and theresults of discordant rate was reduced, Discordant between results of FNAC with washout Tg and final outcomewere 9.2% (27/295) of preoperative LNs and 8.7% (36/412) of postoperative LNs. Due to inconclusive results,unnecessary neck dissection can occur in 13.9% (36/259 dissected cases). Conclusion: To improve diagnosticaccuracy, cut-off values of washout Tg should be applied depending on surgery status. New biomarkers in washoutfluid is necessary to resolve discordant findings.
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