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Research ArticleHead & Neck

Optimized Cutoff Value and Indication for Washout Thyroglobulin Level According to Ultrasound Findings in Patients with Well-Differentiated Thyroid Cancer

J.Y. Jung, J.H. Shin, B.-K. Han and E.Y. Ko
American Journal of Neuroradiology December 2013, 34 (12) 2349-2353; DOI: https://doi.org/10.3174/ajnr.A3687
J.Y. Jung
aFrom the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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J.H. Shin
aFrom the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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B.-K. Han
aFrom the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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E.Y. Ko
aFrom the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Abstract

BACKGROUND AND PURPOSE: Washout thyroglobulin provides evidence for metastatic or recurrent lesions, However, the cutoff value is still controversial. We investigated an optimized cutoff value and indication for the use of washout thyroglobulin from fine-needle aspiration in neck lymph nodes from preoperative or postoperative patients with well-differentiated thyroid cancers.

MATERIALS AND METHODS: A total of 177 lymph nodes from 161 patients underwent sonographically guided fine-needle aspiration cytology and washout thyroglobulin measurement and then underwent surgery and clinical follow-up. We assessed an optimized cutoff value of washout thyroglobulin for diagnosing metastasis and compared its diagnostic performance with that of washout thyroglobulin > 10 ng/mL, the currently accepted cutoff value. We also analyzed diagnostic performances of fine-needle aspiration cytology alone and of the combination of fine-needle aspiration cytology and washout thyroglobulin on the basis of the presence or absence of suspicious ultrasonographic findings.

RESULTS: Of the 177 lymph nodes, 77 were metastases and 100 were benign. An optimized cutoff value for washout thyroglobulin was 1.8 ng/mL. The sensitivity and negative predictive value in diagnosing metastasis improved significantly with a cutoff value of 1.8 ng/mL compared with a cutoff value of 10 ng/mL (P = .0412 for sensitivity, P = .0188 for negative predictive value). In patients with suspicious ultrasonographic findings, applying washout thyroglobulin along with fine-needle aspiration cytology significantly enhanced the sensitivity and negative predictive value of fine-needle aspiration cytology performances to 100% and 100%, respectively (P = .0051, and P = .0088). There was no difference in diagnostic performance between fine-needle aspiration cytology and the combination of the 2 methods in patients without suspicious ultrasonographic findings.

CONCLUSIONS: Applying the optimized cutoff value of washout thyroglobulin of 1.8 ng/mL in patients with suspicious ultrasonographic features facilitates the diagnostic evaluation of neck lymph nodes in both preoperative and postoperative patients with well-differentiated thyroid cancer.

ABBREVIATIONS:

FNA
fine-needle aspiration
FNA-Tg
washout thyroglobulin
NPV
negative predictive value
PPV
positive predictive value
Tg
thyroglobulin
US
ultrasonography
  • © 2013 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 34 (12)
American Journal of Neuroradiology
Vol. 34, Issue 12
1 Dec 2013
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Optimized Cutoff Value and Indication for Washout Thyroglobulin Level According to Ultrasound Findings in Patients with Well-Differentiated Thyroid Cancer
J.Y. Jung, J.H. Shin, B.-K. Han, E.Y. Ko
American Journal of Neuroradiology Dec 2013, 34 (12) 2349-2353; DOI: 10.3174/ajnr.A3687

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Optimized Cutoff Value and Indication for Washout Thyroglobulin Level According to Ultrasound Findings in Patients with Well-Differentiated Thyroid Cancer
J.Y. Jung, J.H. Shin, B.-K. Han, E.Y. Ko
American Journal of Neuroradiology Dec 2013, 34 (12) 2349-2353; DOI: 10.3174/ajnr.A3687
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