Overcoming the Limitations of Fine Needle Aspiration Biopsy: Detection of Lateral Neck Node Metastasis in Papillary Thyroid Carcinoma.
10.3349/ymj.2015.56.1.182
- Author:
Hak Hoon JUN
1
;
Seok Mo KIM
;
Bup Woo KIM
;
Yong Sang LEE
;
Hang Seok CHANG
;
Cheong Soo PARK
Author Information
1. Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
- Publication Type:Original Article
- Keywords:
Papillary thyroid carcinoma;
metastasis
- MeSH:
Adolescent;
Adult;
Aged;
Biopsy, Fine-Needle;
Carcinoma/*diagnosis/*pathology/radiography/surgery;
False Negative Reactions;
Female;
Humans;
Lymph Nodes/*pathology/radiography;
Lymphatic Metastasis/*pathology/radiography;
Male;
Middle Aged;
Multivariate Analysis;
Preoperative Care;
Risk Factors;
Sensitivity and Specificity;
Thyroglobulin/metabolism;
Thyroid Gland/*pathology;
Thyroid Neoplasms/*diagnosis/*pathology/radiography/surgery;
Tomography, X-Ray Computed;
Young Adult
- From:Yonsei Medical Journal
2015;56(1):182-188
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Ultrasound (US) and US-guided fine needle aspiration biopsies (FNAB) are considered the modalities of choice for assessing lymph nodes suspected of containing metastases, but the sensitivity of FNAB varies and is specific to the operator. We analyzed the risk of FNAB providing false negative results of lateral neck node metastasis, and evaluated diagnostic accuracy of FNAB, in patients with papillary thyroid cancer. MATERIALS AND METHODS: FNAB was performed in 242 patients suspected of having lateral neck node metastasis on preoperative imaging. Thyroglobulin in the fine-needle aspirate washout (FNA wash-out Tg) and computed tomography enhancement (Hounsfield units) were measured. Patients with negative results on FNAB were examined by intraoperative frozen section. The false negative and true negative groups were compared. RESULTS: Of the 242 patients, 130 were confirmed as having lateral neck node metastases. In 74 patients, the metastasis was identified by FNAB. False positive results were observed in 2 patients (0.8%) and false negatives in 58 (44.6%). Risk analysis showed that patient age <45 years (p=0.006), tumor size >1 cm (p=0.008) and elevated FNA wash-out Tg (p=0.004) were significantly associated with false negative results on FNAB. The accuracy of FNAB increased significantly when combined with FNA wash-out Tg (p=0.003). CONCLUSION: To reduce the false negative rate of FNAB, patient age (<45 years), tumor size (>1 cm) and FNA wash-out Tg (>34.8 ng/mL) should be considered in preoperative planning. Accuracy may be improved by combining the results of FNAB and FNA wash-out Tg.
