| Objective:Ultrasound-guided thyroglobulin management in fine needle aspiration washout(FNA-Tg)has become an important method to diagnose metastatic cervical lymph node of papillary thyroid carcinoma.However,uniform standards in clinical applications are still needed.The study aims to evaluate the value of FNA-Tg through clinical data of a larger sample,to explore its diagnostic cut-off value,and to analyze the factors of false negative and false positive results to further improve the diagnostic efficacy of FNA-Tg and optimize its clinical application.Methods:A retrospective study collected patients between January 2013 and October 2018,hospitalized in the Department of Thyroid Surgery of China-Japan Union Hospital of Jilin University,who accepted ultrasound-guided FNA-Tg of the lateral cervical lymph node.The basic information and hospitalization data were documented.All patients underwent cervical ultrasonography before surgery.Suspicious lymph nodes were undertaken FNA after ultrasound screening,with puncture specimens for cytological diagnosis(FNA-C)and washout for Tg detection which was washed with 1 ml saline.The blood sample was collected for the detection of Tg(sTg)level,and FNA-Tg/sTg>1(CV-FNA-Tg)was determined as the positive results,conversely,as the negative result.Histopathology is the gold standard: 1)Calculate the sensitivity,specificity and accuracy of FNA-Tg?FNA-C?FNA-Tg and FNAC-Tg for detecting metastatic lateral cervical lymph node of papillary thyroid carcinoma;2)The sample were divided into 6 groups by year.The diagnostic efficiencies of FNAC,FNA-Tg and FNAC-Tg were calculated from 2013 to 2018,and the trend of the line graph was observed;3)Draw the ROC curves of FNA-Tg and FNA-Tg/sTg under different amounts of thyroid tissue,calculate the area under the ROC curve(AUC).Compare AUC of the two indicators,calculate the optimal diagnostic cut-off value under the ROC curve,and analyze its clinical applicability;4)Calculate the false negative rate and false positive rate of FNA-Tg,and make the single-factor and multi-factor analysis to find the causes.Results:1.The sensitivity of ultrasound,FNA-C,FNA-Tg,and FNAC-Tg in this study are 81.7%,87.8%,88.4% and 99.0% respectively,the specificities are 53.2%,97.3%,84.7% and 84.7% respectively,and the accuracy are 76.5%,89.6%,87.8% and 96.4% respectively.2.From 2013 to 2018,the sensitivities of FNAC-Tg are: 100.0%?100.0%?97.0%?100.0%?98.7% and 99.4%,the specificities are: 50.0%?100.0%?76.9%?81.5%?86.9% and 92.0%,and the accuracy are: 93.7%?100.0%?91.5%?95.7%?97.1% and 98.5%.3.The AUC under total resection,not total resection,no history of thyroid surgery,and total sample are 0.96 vs 0.97(p=0.75),0.90 vs 0.81(p=0.46),0.92 vs 0.89(p=0.07),0.92 vs 0.91(p=0.24)respectively.Both AUC under different operating conditions are >0.8,so FNA-Tg and FNA-Tg/sTg all have higher diagnostic accuracy,and there is no statistical difference in AUC.The best diagnostic cut-off value under the ROC curve for FNA-Tg are: 0.65 ng/ml,85.69 ng/ml,32.99 ng/ml,32.99 ng/ml respectively,and for FNA-Tg/sTg are: 1.00,1.00,0.99,0.99 respectively.4.From lymph node ultrasound,biochemical indicators,cytological indicators,pathological diagnosis,operator factors,a total of 12 factors were included in the single-factor and multi-factor analysis for FNA-Tg false negative results.The ultrasound features and sTg are related.Factors such as mis-wear to normal or ectopic thyroid tissue may be associated with false positive results of FNA-Tg.Conclusion:1.Ultrasound-guided FNA-Tg can improve the sensitivity and accuracy for FNA-C alone.FNA-Tg can be used as a powerful supplement way when FNA-C cannot diagnose clearly.2.The diagnostic level of FNAC-Tg is influenced by the learning curve.3.Both the absolute value method(FNA-Tg)and the ratio method(FNA-Tg/sTg)have high diagnostic accuracy and can be used as a washout indicator for preoperative diagnosis of metastatic lymph node.However,the optimal diagnostic standard value of the absolute value method is greatly affected by the residual amount of thyroid tissue,while the best diagnostic standard value of the ratio method(FNA-Tg/sTg>1)is relatively stable,which is more stable in clinical application,so we recommend more.4.Unsuspected ultrasound features and increased sTg in lymph nodes are independent risk factors for false-negative results of FNA-Tg.When the FNA-Tg is similar to the sTg measurement,the interpretation of the results should be careful to avoid false positive results. |
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