文章：

甲状腺癌中央区淋巴结转移的检测：术中细针穿刺冲洗液甲状腺球蛋白测定联合与不联合蓝染剂注射的实用性

Detection of Central Compartment Lymph Node Metastasis of Thyroid Cancer: Usefulness of Intraoperative Thyroglobulin Measurement in Fine Needle Aspiration Washout with and Without Blue Dye Injection

原文发布日期：27 January 2025

DOI: 10.3390/cancers17030422

类型: Article

开放获取: 是

英文摘要：

Background/Objectives: The management of lymph node metastases of the central neck compartment (CNC) in differentiated thyroid carcinoma is debated. The intraoperative measurement of thyroglobulin (Tg) has gained attention in accurately detecting metastases, reducing unnecessary CNC dissections.Methods: A total of 37 patients underwent surgery. An intraoperative assay of thyroglobulin from fine needle aspiration (Tg-FNA) was performed on CNC lymph nodes, identified by blue dye injection in 15 patients (23 nodes, group A) and by palpation in 22 patients (35 nodes, group B). The Tg-FNA values were compared with histology to calculate the diagnostic accuracy.Results: In group A, the blue dye diffused widely, complicating lymph node identification: 2 were metastatic and 21 non-metastatic, with median Tg-FNA levels of 6236 ng/mL and 99.20 ng/mL, respectively. In group B, 8 were metastatic and 27 benign, with median Tg-FNA levels of 4063 ng/mL and 121 ng/mL (p< 0.0001), respectively. ROC analysis identified 500 ng/mL as a cutoff, achieving 100% sensitivity and 74% specificity in group B and 90% sensitivity and 70% specificity overall. Finally, among the non-metastatic lymph nodes, group A exhibited some cases of very high Tg-FNA values compared to group B, with lower accuracy for the cutoff, suggesting that colorant injection might lead to increased Tg-FNA levels.Conclusions:Blue dye injection showed low accuracy. Intraoperative Tg-FNA was reliable in detecting CNC metastases, although a higher cutoff is needed in this compartment compared to what has been reported for lateral lymph nodes. Lymphatic drainage and surgical manipulation might explain these findings. The careful interpretation of Tg-FNA in CNC should be adopted.

摘要翻译： 

背景/目的：分化型甲状腺癌中央区淋巴结转移的处理存在争议。术中甲状腺球蛋白检测在准确识别转移灶、减少不必要的中央区清扫方面受到关注。方法：共纳入37例手术患者。对中央区淋巴结行细针穿刺甲状腺球蛋白检测，其中15例患者（23枚淋巴结，A组）通过蓝染料注射定位，22例患者（35枚淋巴结，B组）通过触诊定位。将Tg-FNA检测值与组织学结果对比以计算诊断准确性。结果：A组中蓝染料弥散广泛，增加了淋巴结识别难度：2枚为转移性，21枚为非转移性，Tg-FNA中位值分别为6236 ng/mL和99.20 ng/mL。B组中8枚为转移性，27枚为良性，Tg-FNA中位值分别为4063 ng/mL和121 ng/mL（p<0.0001）。ROC分析确定500 ng/mL为临界值，在B组中达到100%敏感性和74%特异性，总体达到90%敏感性和70%特异性。值得注意的是，在非转移性淋巴结中，A组部分病例Tg-FNA值显著高于B组，且临界值诊断准确性较低，提示染料注射可能导致Tg-FNA水平升高。结论：蓝染料注射法准确性较低。术中Tg-FNA检测对中央区转移灶具有可靠性，但相较于侧颈淋巴结报道的临界值，中央区需要更高的临界值。淋巴引流和手术操作可能是造成这种现象的原因。临床实践中需审慎解读中央区Tg-FNA检测结果。

原文链接：

Detection of Central Compartment Lymph Node Metastasis of Thyroid Cancer: Usefulness of Intraoperative Thyroglobulin Measurement in Fine Needle Aspiration Washout with and Without Blue Dye Injection