Presentation on theme: "FNA-TG of Neck Nodes in the Patients with PTC is Affected by Serum Concentration of TSH And Thyroglobulin JH Moon 1, YI Kim 2, JA Lim 3, HS Choi 3, SW."— Presentation transcript:
FNA-TG of Neck Nodes in the Patients with PTC is Affected by Serum Concentration of TSH And Thyroglobulin JH Moon 1, YI Kim 2, JA Lim 3, HS Choi 3, SW Cho 3, KW Kim 4, JC Paeng 2, YJ Park 3, KH Yi 5, DJ Park 3, J-K Chung 2 1 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine 2 Department of Nuclear Medicine, Seoul National University College of Medicine 3 Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine 4 Seoul National University Healthcare System Kangnam Center, Seoul National University College of Medicine 5 SMG-SNU Boramae Medical Center, Seoul National University College of Medicine
Measuring the concentration of thyroglobulin directly in the washout of the needle used in FNAC FNA-Tg Factors affecting FNA-Tg and resulting in the discrepancy between the final diagnosis and FNA-Tg Various cut-off value (0.93-50 ng/ml)
To suggest an optimal cut-off value of FNA-Tg to determine malignant LN with a large number of cases from PTC patients To find out parameters affecting FNA-Tg and the diagnosis using FNA-Tg - Evaluation of discrepant results Study objectives
Patient characteristics and FNA-Tg according to the final diagnosis Final diagnosis p-value MalignancyBenign Lymph nodes (n)190338 Patients Sex (male/female, %)30.5/69.524.3/75.70.228* Age (year)52.6 ± 15.049.5 ± 12.40.017 Primary tumor Size (mm)18.0 ± 10.913.5 ± 11.4< 0.001 Multiplicity (yes/no, %)69.5/30.563.1/36.90.203* Lymph nodes metastasis (yes/no, %)87.0/13.059.3/40.7< 0.001* Lymphatic invasion (yes/no, %)51.0/49.027.2/72.8< 0.001* Vascular invasion (yes/no, %)32.3/67.715.7/84.3< 0.001* Extrathyroid extension (yes/no, %)90.3/9.771.6/28.4< 0.001* FNA-Tg (ng/ml)521.2 (3676.8)0.1 (0.2)< 0.001 Serum Tg (ng/ml)1.4 (9.5)0.2 (0.4)< 0.001 FNA-Tg - Serum Tg (ng/ml)333.3 (2397.7)0.0 (0.3)< 0.001 Data are expressed as mean ± SD or median (interquatile range). FNA-Tg, thyroglobulin in the needle washout fluid of fine-needle aspiration cytology *Derived from a Chi-square test. Derived from a Student's T test. Derived from a Mann-Whitney U test.
Validation of Cut-off value (FNA-Tg vs. FNA-Tg – serum Tg) Included lymph nodes Cut-off value Sensitivity (%)Specificity (%) FNA-Tg (ng/ml) FNA-Tg - serum Tg (ng/ml) Surgically resected LNs only (n =165) 1.11 93.888.9 0.1587.489.7 Surgically resected LNs and LNs F/U for 36 months or more (n = 255) 1.11 94.195.0 0.4087.395.3 Surgically resected lymph nodes and LNs F/U for 24 months or more (n = 377) 0.99 94.295.5 0.4087.796.1 Surgically resected lymph nodes and LNs F/U for 12 months or more (n = 528, all cases) 1.0 93.295.9 0.4885.796.7
Diagnostic performance ROC of FNA-Tg for Dx of malig. LN. in all cases Optimal cut-off value: 1.0 ng/ml AUC: 0.967 (95% CI 0.949-0.984) Diagnosis modalitySensitivity (%)Specificity (%) FNAC83.6*98.2* FNA-Tg (cut off value, 1.0 ng/ml)93.2*95.9* FNA-Tg (1.0 ng/ml) + FNAC98.494.4 *p < 0.05 vs. FNA-Tg + FNAC, derived from a McNemar test.
The cut-off value of FNA-Tg according to the presence of thyroid gland Prior to thyroidectomyAfter thyroidectomy 2.24 ng/ml (95.0%, 96.3%) AUC: 0.987 (95% CI 0.975-0.999) 1.09 ng/ml (90.8%, 96.5%) AUC: 0.956 (95% CI 0.932-0.980)
FNA-Tg, serum Tg and TSH according to the presence of thyroid gland FNA-Tg 201.0 (3884.77) 0.1 (2.90)
All casesMalignant casesBenign cases Serum Tg Correlated ρ = 0.383 p < 0.001 Correlated ρ = 0.228 p = 0.004 Correlated ρ = 0.210 p < 0.001 Serum TSH Correlated ρ = 0.210 p < 0.001 Correlated ρ = 0.335 p < 0.001 Not correlated ρ = 0.075 p = 0.183 Correlation of FNA-Tg with serum Tg or TSH
Correlation of FNA-Tg with TgAb TgAb -TgAb + 0.1 (7.15) 0.3 (71.46)
Serum TSH and Tg on the diagnosis from FNA-Tg Logistic regression analysis of serum TSH and Tg with the diagnosis using FNA-Tg cut-off value 1.0 ng/ml Odd ratio 95% confidence interval for odds ratio p-value LowerUpper Serum TSH1.1711.0381.3210.01 Serum Tg1.0351.0121.0590.003 The dependent variable was the diagnosis using ENA-Tg cut off value 1.0 ng/ml, and the independent variables were serum TSH and Tg levels. Odd ratio 95% confidence interval for odds ratio p-value LowerUpper No serum TSH suppression2.8711.7944.595< 0.001 Serum Tg presence1.9801.2613.1090.003 The dependent variable was the diagnosis using ENA-Tg cut off value 1.0 ng/ml, and the independent variables were no serum TSH suppression (serum TSH 0.4 mU/l) and serum Tg presence (serum Tg 0.2 ng/ml). Logistic regression analysis of serum TSH suppression and serum Tg presence with the diagnosis using FNA-Tg cut-off value 1.0 ng/ml
Optimal cut-off value of FNA-Tg was 1.0 ng/ml FNA-Tg + FNAC showed better diagnostic rate than FNAC or FNA-Tg alone. FNA-Tg was correlated with serum Tg and TSH, not with TgAb. The diagnosis using FNA-Tg can be affected by serum TSH and Tg levels. Summary
The combination of FNAC and FNA-Tg can complement the low sensitivity of FNAC alone. TSH suppression and the presence of serum Tg should be considered for accurate FNA-Tg-based diagnosis of metastatic malignant LNs in PTC patients. Conclusion