Utilidad de la tiroglobulina en lavado de aguja del aspirado de 16 lesiones cervicales en pacientes con cáncer de tiroides / The value of thyroglobulin in washout of fine needle aspirate from 16 cervical lesions in patients with thyroid cancer

Antecedentes y objetivo La tiroglobulina del lavado de aguja (Tg-PAAF) junto con la citología de la punción-aspiración con aguja fina (cito-PAAF) son procedimientos recomendados para el diagnóstico de metástasis ganglionares cervicales y recurrencias del cáncer diferenciado de tiroides. El objetivo de este estudio fue valorar la utilidad de estas técnicas en 16 lesiones cervicales de pacientes con cáncer de tiroides del epitelio folicular (CT).Pacientes y método Se incluyeron 6 pacientes con CT y adenopatías laterocervicales evaluadas antes de la cirugía tiroidea inicial y 10 pacientes en seguimiento por CT ya operado y lesiones cervicales ecográficamente sospechosas y/o persistentes. Las 16 lesiones fueron sometidas a PAAF. Los resultados de la Tg-PAAF, cito-PAAF y de la combinación de ambas se compararon con el diagnóstico definitivo asignado a cada lesión. Resultados En 10 lesiones comprobadamente malignas tras extirpación quirúrgica (9 metástasis ganglionares y una recurrencia en lecho), la cito-PAAF, la Tg-PAAF y la combinación de ambas técnicas permitieron llegar al diagnóstico correcto en 7, 9 y 10 casos respectivamente. En 6 lesiones consideradas benignas, la cito-PAAF pudo confirmar la benignidad de la lesión en 4, resultó no diagnóstica en una y falsamente positiva en otra, mientras que la Tg-PAAF se halló por debajo del valor de corte establecido (para considerar malignidad) en todos los casos. Conclusiones En pacientes con CT y lesiones cervicales sospechosas, la Tg-PAAF mejora la rentabilidad diagnóstica de la cito-PAAF aislada justificándose así su recomendación sistemática al realizar la PAAF. Quedan sin embargo por definir una estandarización universal de la técnica y unos valores de corte válidos de Tg-PAAF (de acuerdo al inmunoanálisis empleado) por encima de los cuales considerar la lesión maligna (AU)

Background and objective Thyroglobulin in the needle washout (Tg-FNA) and cytology of fine needle aspiration (cyto-FNA) are recommended for diagnosis of metastatic lymphadenopathies and recurrence of differentiated thyroid cancer. The objective of this study was to assess the value of these procedures in 16 cervical masses from patients with thyroid cancer of the follicular epithelium (TC).Patients and methods The study included six patients with TC and cervical lymphadenopathies evaluated before initial thyroid surgery and 10 patients followed up after TC surgery with cervical lumps discovered. FNA was performed in all 16 masses. Results of cyto-FNA, Tg-FNA and of the combined tests were compared to the final diagnosis of each lesion. Results Among 10 lesions proven to be malignant at surgery, cyto-FNA, Tg-FNA and the combination of both allowed for adequate diagnosis in 7, 9, and 10 cases respectively. Among 6 lesions considered to be benign, cyto-FNA was able to confirm diagnosis in 4, was non-diagnostic in one, and was falsely negative in the remaining case, while Tg-FNA was below the established cut-off value (to consider malignancy) in all cases. ConclusionsIn patients with TC and suspect cervical masses, Tg-FNA improved the diagnostic yield of cyto-FNA alone, thus warranting its routine recommendation when FNA is performed. However, universal standardization of the technique and definition of valid cut-off thyroglobulin values (depending on the immunoassay used) above which the lesion should be considered to be malignant are still pending (AU)

The value of thyroglobulin in washout of fine needle aspirate from 16 cervical lesions in patients with thyroid cancer.

BACKGROUND AND OBJECTIVE: Thyroglobulin in the needle washout (Tg-FNA) and cytology of fine needle aspiration (cyto-FNA) are recommended for diagnosis of metastatic lymphadenopathies and recurrence of differentiated thyroid cancer. The objective of this study was to assess the value of these procedures in 16 cervical masses from patients with thyroid cancer of the follicular epithelium (TC). PATIENTS AND METHODS: The study included six patients with TC and cervical lymphadenopathies evaluated before initial thyroid surgery and 10 patients followed up after TC surgery with cervical lumps discovered. FNA was performed in all 16 masses. Results of cyto-FNA, Tg-FNA and of the combined tests were compared to the final diagnosis of each lesion. RESULTS: Among 10 lesions proven to be malignant at surgery, cyto-FNA, Tg-FNA and the combination of both allowed for adequate diagnosis in 7, 9, and 10 cases respectively. Among 6 lesions considered to be benign, cyto-FNA was able to confirm diagnosis in 4, was non-diagnostic in one, and was falsely negative in the remaining case, while Tg-FNA was below the established cut-off value (to consider malignancy) in all cases. CONCLUSIONS: In patients with TC and suspect cervical masses, Tg-FNA improved the diagnostic yield of cyto-FNA alone, thus warranting its routine recommendation when FNA is performed. However, universal standardization of the technique and definition of valid cut-off thyroglobulin values (depending on the immunoassay used) above which the lesion should be considered to be malignant are still pending.