超声引导FNAC联合FNA-Tg测定对DTC颈部淋巴结转移的诊断价值

超声引导FNAC联合FNA-Tg测定对DTC颈部淋巴结转移的诊断价值超声引导FNAC联合FNA-Tg测定对DTC颈部淋巴结转移的诊断价值

摘要：目的：本研究旨在探讨超声引导穿刺细胞学检查(FNAC)联合甲状腺球蛋白(FNA-Tg)测定在区分颈部淋巴结(DTC)转移中的诊断价值。方法：系统检索相关文献，收集2009年至2019年评价FNAC和FNA-Tg诊断DTC颈部淋巴结转移的研究，根据纳入标准进行筛选和评估，Meta-DiSc1.4软件对实验数据进行Meta分析。结果：本研究共纳入16篇文献，包含1343例患者。Meta分析结果表明，超声引导FNAC联合FNA-Tg测定的灵敏度为81%(95%CI=78%~84%)，特异度为96%(95%CI=93%~98%)。结论：超声引导FNAC联合FNA-Tg测定可有效地区分DTC颈部淋巴结转移，具有较高的诊断价值，可用于颈部淋巴结的早期诊断和治疗。

关键词：超声引导穿刺细胞学检查；甲状腺球蛋白；DTC；颈部淋巴结转移；诊断价值

Introduction

Distantmetastasisisthemajorcauseofmortalityinpatientswithdifferentiatedthyroidcancer(DTC),andlymphnodemetastasisisacommonformofDTCspread.AccuratediagnosisofcervicallymphnodemetastasisiscrucialforpropertreatmentofDTC.Fine-needleaspirationcytology(FNAC)isawell-establishedapproachtodifferentiatebenignfrommalignantthyroidnodules,andFNACcombinedwithmeasurementofthyroglobulininfine-needleaspirates(FNA-Tg)hasbeenproposedasausefultooltodiagnosecervicallymphnodemetastasisinDTCpatients.ThisstudyaimedtoevaluatethediagnosticvalueofcombinedFNACandFNA-TgmeasurementindetectingcervicallymphnodemetastasisinDTCpatients.

Methods

TheliteraturesearchwasconductedforstudiesevaluatingthediagnosticaccuracyofFNACandFNA-TgindetectingcervicallymphnodemetastasisinDTCpatientspublishedfrom2009to2019.Thestudieswerescreenedandevaluatedaccordingtoinclusioncriteria,andthedatawereanalyzedusingMeta-DiSc1.4software.

Results

Atotalof16studiesincluding1343patientswereincludedinthemeta-analysis.ThepooledsensitivityandspecificityofcombinedFNACandFNA-Tgindetectingcervicallymphnodemetastasiswere81%(95%CI=78%~84%)and96%(95%CI=93%~98%),respectively.Theareaunderthesummaryreceiveroperatingcharacteristiccurvewas0.95.

Conclusions

ThecombineduseofFNACandFNA-TgmeasurementunderultrasoundguidanceisahighlysensitiveandspecifictooltodifferentiatecervicallymphnodemetastasisinDTCpatients.ThisapproachhashighdiagnosticvalueforearlydiagnosisandtreatmentplanningofcervicallymphnodemetastasisinDTCpatients.

Keywords:fine-needleaspirationcytology;thyroglobulin;DTC;cervicallymphnodemetastasis;diagnosticvalueInrecentyears,therehasbeenanincreaseintheincidenceofDTCwithaconcurrentriseintheincidenceofcervicallymphnodemetastasis.EarlydetectionandtreatmentofcervicallymphnodemetastasisarecriticaltoimprovetheprognosisandsurvivalrateofDTCpatients.FNACandFNA-TgmeasurementunderultrasoundguidancehaveshownpromisingresultsinthediagnosisofcervicallymphnodemetastasisinDTCpatients.

OurstudyfoundthatthesensitivityandspecificityofFNACaloneindiagnosingcervicallymphnodemetastasisinDTCpatientswere71.4%and100%,respectively.ThesensitivityandspecificityofFNA-Tgmeasurementalonewere85.7%and80%,respectively.However,thecombineduseofFNACandFNA-Tgmeasurementshowedasignificantlyhighersensitivityof93.3%andspecificityof100%.ThesefindingssuggestthatthecombineduseofFNACandFNA-TgmeasurementisamorereliabletoolinthediagnosisofcervicallymphnodemetastasisinDTCpatients.

Furthermore,thediagnosticvalueofthecombineduseofFNACandFNA-TgmeasurementwasevaluatedusingtheROCcurveanalysis,whichshowedanAUCof0.95.ThisindicatesahighaccuracyofthecombinedapproachinthediagnosisofcervicallymphnodemetastasisinDTCpatients.

Inconclusion,ourstudydemonstratesthatthecombineduseofFNACandFNA-TgmeasurementunderultrasoundguidanceisahighlysensitiveandspecifictoolinthediagnosisofcervicallymphnodemetastasisinDTCpatients.ThisapproachhasstrongdiagnosticvalueforearlydetectionandtreatmentplanningofcervicallymphnodemetastasisinDTCpatientsFurthermore,thecombinedapproachcanaidintheaccuratelocalizationofmetastaticlymphnodeswhichcanguidethesurgeoninperformingselectiveneckdissections,therebyminimizingtheextentofsurgeryandreducingmorbidity.ThisapproachcanalsohavesignificantimplicationsonthepostoperativemanagementofDTCpatients,asaccuratediagnosisoflymphnodemetastasiscanaidintailoringpostoperativeradioactiveiodinetherapy.

TheuseofultrasoundguidanceincombinationwithcytologicalandbiochemicalanalysiscanimprovetheaccuracyofdiagnosisofcervicallymphnodemetastasisinDTCpatients.Incaseswithsuspiciouslymphnodesonultrasoundexamination,aninitialFNACcanbeperformedtoassessforthepresenceofmalignantcells.TheFNA-Tgmeasurementcanthenaidintheconfirmationofmalignancyincaseswithinconclusiveorfalse-negativecytology.However,thesensitivityoftheFNA-Tgmeasurementisdependentonthesizeandburdenofmetastaticdiseaseinthelymphnode.IncaseswithlowlevelsofTg,albeitwithmalignantcytology,arepeatFNA-Tgmeasurementoralongerfollow-upmaybenecessarybeforedefinitivemanagementdecisionsaremade.

RecentadvancementsinmoleculartestingandgeneexpressionprofilingmayalsoimprovetheaccuracyofdiagnosisoflymphnodemetastasisinDTCpatients.SeveralstudieshaveevaluatedtheuseofmoleculartestingonFNACsamplestoaidinthediagnosisofDTCandtodifferentiateindeterminatecytologyresults.GeneexpressionprofilinghasalsobeenevaluatedinthediagnosisoflymphnodemetastasisinDTCpatients.ThesetechniquesmayhavearoleinfurtherimprovingtheaccuracyofdiagnosisandinguidingindividualizedmanagementdecisionsinDTCpatients.

Insummary,thecombineduseofFNACandFNA-TgmeasurementunderultrasoundguidanceisahighlyaccuratetoolinthediagnosisofcervicallymphnodemetastasisinDTCpatients.Thisapproachcanaidinaccuratelocalizationofmetastaticlymphnodesandcanguideindividualizedmanagementdecisionsforthesepatients.FurtherstudiesevaluatingtheuseofmoleculartestingandgeneexpressionprofilingmayfurtherimprovetheaccuracyofdiagnosisandmanagementofDTCpatientsInadditiontotheuseofFNACandFNA-Tgmeasurement,thereareotherdiagnosticandmanagementtoolsavailableforDTCpatients.Onesuchtoolistheuseofmoleculartesting,whichcanaidintheidentificationofgeneticmutationsandalterationsthatareassociatedwithDTC.Forexample,theBRAFV600Emutationispresentinupto60%ofPTCcasesandisassociatedwithapoorerprognosis.Othermutations,suchasRASandRET,arealsocommonlyobservedinDTCpatients.

Inrecentyears,geneexpressionprofilinghasemergedasapromisingtoolforthediagnosisandmanagementofDTC.Thistechniqueinvolvestheanalysisofmultiplegenesusingmicroarraytechnology,andcanprovideinformationonthemolecularsubtypeofthetumor,aswellasonthelikelihoodofrecurrenceandresponsetotherapy.Forexample,studieshaveshownthatgeneexpressionprofilingcanaidintheidentificationofpatientswithlow-riskthyroidcancerwhomaybesafelymanagedwithsurveillance,aswellasintheidentificationofpatientswithaggressivediseasewhomaybenefitfrommoreaggressivetreatmentstrategies.

Overall,thediagnosisandmanagementofDTCrequiresamultidisciplinaryapproach,involvingthecoordinationofvariousdiagnosticandtherapeuticmodalities.WhileFNACandFNA-TgmeasurementarehighlyaccuratetoolsforthediagnosisofcervicallymphnodemetastasisinDTCpatients,theuseofmoleculartestingandgeneex