endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg9824endoserg-9824Research ArticleОригинальное исследованиеOriginal studyОпределение тиреоглобулина в смыве из пункционной иглы в дифференциальной диагностике шейной лимфаденопатии у пациентов с высокодифференцированным раком щитовидной железыThyroglobulin measurement in fine-needle aspirates of lymph nodes in patients with differentiated thyroid cancerhttps://orcid.org/0000-0001-6953-6928ЗураеваЗамира ТотразовнаZuraevaZamira T.

научный сотрудник

MD

zuraeva_zamira@mail.ruhttps://orcid.org/0000-0002-1120-8240НиканкинаЛариса ВячеславовнаNikankinaLarisa V.

к.м.н.

MD, PhD

larisa.nikankina@yandex.ruhttps://orcid.org/0000-0002-3121-5122КолесниковаГалина СергеевнаKolesnikovaGalina S.

д.б.н.

PhD

kolesnikova21@yandex.ruАбдулхабироваФатима МагомедовнаAbdulhabirovaFatima M.

к.м.н.

MD, PhD

a-fatima@yandex.ruhttps://orcid.org/0000-0002-7721-634XРумянцевПавел ОлеговичRumiantsevPavel O.

д.м.н.

MD, PhD

pavelrum@gmail.comhttps://orcid.org/0000-0001-6338-7490ВанушкоВладимир ЭдуардовичVanushkoVladimir E.

д.м.н.

MD, PhD

vanushko.thyroid@gmail.comhttps://orcid.org/0000-0001-7321-9052МалышеваНаталья МихайловнаMalyshevaNatalia M.

к.б.н.

PhD

natalya.m@list.ru<p>ФГБУ &ldquo;Национальный медицинский исследовательский центр эндокринологии&rdquo; Минздрава России</p>Россия<p>Endocrinology Research Centre</p>Russian Federation2019070820191311725Copyright &#x00A9; Зураева З.Т., Никанкина Л.В., Колесникова Г.С., Абдулхабирова Ф.М., Румянцев П.О., Ванушко В.Э., Малышева Н.М., 20192019Зураева З.Т., Никанкина Л.В., Колесникова Г.С., Абдулхабирова Ф.М., Румянцев П.О., Ванушко В.Э., Малышева Н.М.Zuraeva Z.T., Nikankina L.V., Kolesnikova G.S., Abdulhabirova F.M., Rumiantsev P.O., Vanushko V.E., Malysheva N.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/9824Обоснование

Обоснование. Высокая частота регионарного метастазирования при высокодифференцированном раке щитовидной железы (ВДРЩЖ) и недостаточная информативность существующих методов диагностики определяют актуальность поиска более точных тестов.

Цель настоящего исследования – определить прогностическую значимость определения тиреоглобулина в смыве из пункционной иглы (ТАБ-ТГ) и порог диагностического уровня в выявлении регионарных метастазов ВДРЩЖ.

Методы

Методы. Ретроспективное исследование, включившее 245 пациентов с рецидивом ВДРЩЖ (n = 123) и узловыми изменениями в щитовидной железе (n = 122) с подозрительными одиночными или множественными регионарными лимфатическими узлами. Всем пациентам была выполнена ТАБ-ТГ, исследованы уровни сывороточного тиреоглобулина (сТГ), антител к тиреоглобулину (АТ-ТГ), тиреотропного гормона (ТТГ). У 125 пациентов со злокачественными изменениями по данным ТАБ и/или высокими значениями ТГ в смыве было выполнено оперативное лечение. На основании данных гистологического исследования послеоперационного материала все пациенты были разделены на две группы: с реактивными (n = 23) и метастатическими (n = 102) изменениями в лимфатических узлах. Определение ТГ в смыве выполняли на автоматизированной системе Cobas 601 (Roche, Франция).

Результаты

Результаты. Все пациенты были сопоставимы по полу, возрасту и уровню ТТГ, сТГ, АТ-ТГ. Медиана ТАБ-ТГ в группе пациентов с метастатическим поражением лимфоузлов составила 537,0 [0,1; 1000], в группе пациентов с реактивными изменениями – 17,9 [0,5; 158,0], р = 0,003. Чувствительность изолированной ТАБ составила 85%, специфичность – 57%, AUC = 0,618, 95% ДИ 0,516–0,713. Чувствительность и специфичность ТАБ-ТГ – 73 и 100% соответственно, AUC = 0,862, 95% ДИ 0,78–0,92. Оптимальной точкой cut-off для определения злокачественности заболевания установлено значение >9,2 нг/мл (чувствительность 75%, специфичность 100%), индекс Юдена 0,73.

Заключение

Заключение. Дополнительный анализ содержания ТГ в смыве пункционной иглы повышает чувствительность ТАБ в диагностике регионарных метастазов ВДРЩЖ. Значение >9,2 нг/мл может быть рекомендовано в качестве порогового значения положительного результата исследования.

Background

Background: The high incidence of cervical lymph nodes metastasis in highly differentiated thyroid carcinoma (DTC) and insufficient of existing diagnostic methods determines the urgency of finding reliable and more effective tests.

Aims

Aims: The aim of our study is to determine the prognostic significance of the thyroglobulin measurement in washout fluid from fine-needle aspiration biopsy (FNA-Tg) and the cut-off value in the diagnosis of DTC lymph nodes metastasis.

Materials and methods

Materials and methods: 245 patients evaluated for suspicious cervical lymph nodes were retrospectively reviewed. All patients underwent FNA-Tg, serum thyroglobulin (sTg) levels, thyroglobulin antibodies (Tg-Ab), thyroid-stimulating hormone (TSH) were measured. 125 patients with malignant changes according to FNA and/or high FNA-Tgvalues underwent surgical treatment. Patients were divided into 2 groups with reactive (n = 23) and metastatic (n = 102) changes. FNA-TG was assayed on automated system Cobas 601 (Roche, France).

Results

Results: All patients were comparable by sex, age and levels of TSH, sTG, Tg-Ab. The FNA-Tg median in metastatic group was 537.0 [0.1; 1000], and in benign group – 17.9 [0.5; 158.0], p = 0.003. The sensitivity of isolated FNA was 85%, specificity 57%, AUC = 0.618, 95% CI 0.516–0.713. The sensitivity and specificity of FNA-Tg was 73% and 100%, respectively, AUC = 0.865, 95% CI 0.78–0.92. The optimal cut-off point for malignancy was >9.2 ng/ml (sensitivity 75%, specificity 100%), Youden Index 0.73.

Conclusions

Conclusions: Additional FNA-Tg may increase the sensitivity of isolated FNA in evaluation of DTC lymph node metastasis. The optimized cut-off value >9.2 ng/ml can be proposed as a diagnostic threshold for the definition of malignancy.

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The authors declare that there are no conflicts of interest present.