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目的 探讨细针穿刺细胞学(fine-needle aspiration cytology, FNAC)检查、穿刺洗脱液甲状腺球蛋白(fine-needle aspiration cytology with needle-wash thyroglobulin, FNA-Tg)测定及甲状腺球蛋白(thyroglobulin, Tg)免疫细胞化学染色在术前甲状腺乳头状癌(papillary thyroid carcinoma, PTC)淋巴结转移诊断中的价值，并分析血清Tg水平和促甲状腺激素(thyroidstimulating hormone,TSH)水平对FNA-Tg诊断PTC淋巴结转移效能的影响。方法 选取2022年3月至2023年4月期间，在本院行甲状腺切除合并颈部淋巴结清扫手术的98例患者共164个淋巴结。所有患者术前均行常规血清Tg、TSH测定、超声检查、FNAC检查及FNA-Tg测定，对组织病理学确定转移的33个淋巴结行Tg免疫细胞化学染色。分析FNA-Tg、Tg对FNAC的辅助诊断价值及术前血清Tg、TSH与FNA-Tg的相关性。结果 单因素分析提示淋巴结转移组FNA-Tg、血清Tg水平分别高于非转移组(P<0.05),多因素二元逻辑回归分析显示，FNA-Tg是PTC淋巴结转移诊断的影响因素(P<0.001)。FNA-Tg诊断PTC术前淋巴结转移的最佳阈值为98.605 ng/mL。FNA-Tg联合FNAC检测的敏感性、特异性、准确性分别为88.3%、95.1%、90.9%;FNAC、FNA-Tg及联合检测，各诊断方法检测PTC术前淋巴结转移无统计学差异(P>0.05)。FNAC、FNA-Tg、联合检测的准确性、曲线下面积(AUC)分别为85.4%、85.4%、90.9%和0.767、0.714、0.834。Tg免疫细胞化学染色阳性率为100%。血清Tg、TSH水平与FNA-Tg诊断效能呈弱相关。结论 根据肿瘤细胞数量，FNA-Tg和/或Tg免疫细胞化学染色可作为FNAC的辅助诊断。FNA-Tg诊断的准确性受血清Tg、TSH水平的影响不明显。
Abstract：Objective To investigate the diagnostic value of fine-needle aspiration cytology(FNAC) with needle-wash thyroglobulin(FNA-Tg) and thyroglobulin immunocytochemical staining for lymph node metastasis of preoperative papillary thyroid carcinoma(PTC) and its influencing factors. Methods A total of 164 suspected metastatic lymph nodes from 98 patients who underwent thyroidectomy and cervical lymphadenectomy were selected in the study. Serum Tg, serum thyroidstimulating hormone(TSH), ultrasonography, FNAC and FNA-Tg results were acquired in all patients. Tg immunocytochemical staining was performed on 33 lymph nodes with metastasis by histopathology. The correlation between preoperative serum Tg, serum TSH and lymph node FNA-Tg level were analyzed. Results Univariate analysis suggested that FNA-Tg and serum Tg levels were higher in lymph node metastasis group than in non-metastasis group(P<0.05), multivariate binary logistic regression analysis showed that FNA-Tg was an influential factor in the diagnosis of PTC lymph node metastasis diagnosis(P<0.001). The optimal threshold value of FNA-Tg was 98.605 ng/mL. The sensitivity, specificity and accuracy of combined detection were 88.3%, 95.1%, 90.9%, respectively. FNAC, FNA-Tg and combined detection were no significant differences(P>0.05). The accuracy and area under the curve(AUC) of FNAC, FNA-Tg and combined detection were 85.4%, 85.4% and 90.9% and 0.767, 0.714 and 0.834, respectively. The positive rate of Tg immunocytochemistry was 100%. Serum Tg and TSH levels were weakly correlated with accuracy of FNA-Tg respectively. Conclusions Depending on the number of tumor cells, choosing FNA-Tg and/or Tg immunocytochemistry staining can be used as auxiliary diagnostic of FNAC. The diagnostic accuracy of FNA-Tg was not significantly affected by serum Tg and TSH levels.
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基本信息:
中图分类号:R736.1
引用信息:
[1]杨波,林珍珍,张钱磊,等.FNA-Tg、Tg对术前甲状腺乳头状癌淋巴结转移的诊断价值及相关性分析[J].新疆医科大学学报,2023,46(11):1507-1512.
基金信息:
新疆维吾尔自治区自然科学基金项目(2021D01C408); 新疆维吾尔自治区卫生健康青年医学科技人才专项科研项目(WJWY-202152)
2023-11-15
2023-11-15