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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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Article Figures & Data

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  • Fig 1.
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    Fig 1.

    Ultrasonography of a 73-year-old man who had a small cystic nodule (A, cross) in the left thyroid gland and a suspicious cystic level VI lymph node (B, arrow). US-guided FNA cytology was performed on the small cystic thyroid nodule and the level VI cystic node, and the results were suspicious for papillary thyroid carcinoma from a nodule and a few pigmented macrophages from a lymph node. However, metastasis was considered due to the high FNA-Tg level of 1023 ng/mL. Final surgical pathology revealed a tiny papillary thyroid carcinoma of the left thyroid gland and nodal metastasis.

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    Fig 2.

    A 39-year-old female patient who underwent total thyroidectomy. The patient had a palpable lymph node (cross) in level V and no suspicious US feature. Even though the lymph node had inadequate FNA cytology due to a few hemosiderin-laden macrophage and lymphoid cells, it was considered benign because of its low FNA-Tg level. The node showed no changes in a 2-year follow-up. According to our results, there was no significant diagnostic enhancement of FNA-Tg in patients without suspicious US findings.

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    Fig 3.

    Flow chart of recommended management of clinically suspicious lymph nodes in patients with well-differentiated thyroid carcinoma from our results.

Tables

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    Table 1:

    Clinical, imaging, and cytopathologic characteristics of 177 lymph nodes

    CharacteristicsTotal (n = 177) (%)
    Age (mean) (yr)47 (range, 15–85)
    Sex (female/male)127:50
    Mean lesion size (mean) (cm)1.0 (range, 0.2–3.6)
    Patient status
         Preoperative81 (46)
         Postoperative96 (54)
    Suspicious malignant US features
         Yes109 (62)
         No68 (38)
    Initial FNA
         Malignant66 (37)
         Benign94 (53)
         Inadequate17 (10)
    Final cytopathology
         Malignant77 (44)
         Benign100 (56)
    Reference standard
         Surgical excision81 (46)
         Follow-up96 (54)
    • View popup
    Table 2:

    Comparison between diagnostic performances of washout Tg ≥ 1.8 ng/mL and > 10 ng/mL

    %SensitivitySpecificityPPVNPVAccuracy
    Washout Tg > 1088.396.094.491.492.7
    Washout Tg ≥1.896.194.092.596.994.9
    P value.0412.4795.2879.0188.2888
    • View popup
    Table 3:

    Diagnostic performance of suspicious US findings for 177 lymph nodesa

    SensitivitySpecificityPPVNPVAccuracy
    Microcalcification27.3 (21/77)95.0 (95/100)80.8 (21/26)62.9 (95/151)65.5 (116/177)
    Cystic change28.6 (22/77)96.0 (96/100)84.6 (22/26)63.6 (96/151)66.7 (118/177)
    Hyperechoic cortex42.9 (33/77)89.0 (89/100)75.0 (33/44)66.9 (89/133)68.9 (122/177)
    Not oval shape15.6 (12/77)86.0 (86/100)46.1 (12/26)57.0 (86/151)55.3 (98/177)
    Irregular margin26.0 (20/77)95.0 (95/100)80.0 (20/25)62.5 (95/152)65.0 (115/177)
    At least 1 of US findings96.1 (74/77)65.0 (65/100)67.9 (74/109)95.6 (65/68)78.5 (119/177)
    • ↵a Data are percentages.

    • View popup
    Table 4:

    Comparison of diagnostic performances of FNA-C and FNA-C with FNA-Tg according to US features using washout Tg ≥ 1.8a

    US FeatureSensitivitySpecificityPPVNPVAccuracy
    Overall
         FNA-C84.499.098.589.292.1
         FNA-C+FNA-Tg10093.091.710096.1
         P value.0015b.04123b.0235b.0011b.2386
    Positive
         FNA-C85.197.198.475.688.9
         FNA-C+FNA-Tg10091.496.110097.3
         P value.0051b.9590.4149.0088b.0530
    Negative
         FNA-C66.710010098.598.5
         FNA-C+FNA-Tg10093.942.910061.7
         P value1.0000.133602482.3212.3711
    • Note:—FNA-C indicates FNA cytology.

    • ↵a Data other than P values are percentages.

    • ↵b Significant.

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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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