PURPOSE: The purpose was to compare the frequency of metastatic and nonmetastatic lymph nodes diagnosed by fine needle aspiration biopsy cytology (FNAC) and thyroglobulin concentration from fine needle aspiration biopsy washout fluid (FNAB-Tg) in an indeterminate range (0.2-100 ng/mL), and to evaluate the most appropriate threshold value of FNAB-Tg in an indeterminate range. MATERIALS AND METHODS: We performed ultrasound-guided FNAB and FNAB-Tg in suspicious metastatic cervical lymph nodes of papillary thyroid carcinoma and performed surgery. Ninety-five lymph nodes with indeterminate values of FNAB-Tg ranging from 0.2-100 ng/mL in ninety-two patients were included in this study. The diagnostic performances in multiple Tg levels (0.7, 1.0, 5.0, 10.0, 20.0, 50.0) were evaluated to compare with FNAB cytology using sensitivity, specificity, and accuracy with area under the curve (AUC) analysis. RESULTS: Forty-two were metastatic lymph nodes and fifty three were nonmetastatic lymph nodes. FNAB-Tg ranged from 0.22 to 90.9 ng/mL in metastatic lymph nodes (mean; 34.3+/-33.3 ng/mL) and 0.20 to 56.7 ng/mL in nonmetastatic lymph nodes (mean; 4.9+/-11.1 ng/mL) (p<0.001). The most excellent diagnostic performance was displayed in 5 ng/mL of FNAB-Tg with AUC of 0.76, sensitivity, specificity, accuracy, 69.0, 83.0, and 76.8, respectively. However, there was no significant difference from 10 ng/mL FNAB. CONCLUSION: We ascertained that 5 ng/mL yielded the most excellent diagnostic performance among FNAB-Tg levels in the present setting with a large series with the indeterminate range (0.2-100 ng/mL) of FNAB-Tg values. These results need additional confirmation under different laboratory conditions.
Biopsy, Fine-Needle/*methods/standards/statistics & numerical data ; Body Fluids/metabolism ; Carcinoma, Papillary/*metabolism/*secondary/ultrasonography ; Humans ; Lymph Nodes/metabolism/pathology/ultrasonography ; Lymphatic Metastasis ; Retrospective Studies ; Sensitivity and Specificity ; Thyroglobulin/*metabolism ; Thyroid Neoplasms/*metabolism/*secondary/ultrasonography ; Ultrasonography, Interventional

OBJECTIVE: Our goals were to determine the added value of fine-needle aspiration biopsy (FNAB)-thyroglobulin (Tg) measurements over FNAB-cytology alone for diagnosing metastatic nodes, and to determine whether the ultrasound features of lymph nodes can be used to identify lymph nodes that may benefit from FNAB-Tg measurement in patients with papillary thyroid cancer. MATERIALS AND METHODS: We retrospectively evaluated 76 surgically proven cervical lymph nodes. Twenty-nine patients were awaiting surgery and 18 patients had undergone thyroid surgery for papillary thyroid cancer. Ultrasound-guided FNAB and Tg measurements were performed and the ultrasound features were evaluated. RESULTS: The accuracies, sensitivities, and specificities of FNAB-cytology, FNAB-Tg, and combined FNAB-Tg/cytology were 90%, 80%, and 100%; 92%, 95%, and 90%; and 93%, 96%, and 90%, respectively. The diagnostic sensitivity of FNAB-Tg for metastatic nodes was significantly higher than that of FNAB-cytology (p = 0.011). Furthermore, combined FNAB-Tg/cytology significantly increased sensitivity (p = 0.002) and accuracy (p = 0.03) as compared with FNAB-cytology. CONCLUSION: Combined FNAB-Tg/cytology is significantly more sensitive and accurate at detecting metastatic nodes than FNAB-cytology alone. FNAB-Tg was better at diagnosing metastases in small lymph nodes.
Biopsy, Fine-Needle ; Carcinoma, Papillary/*pathology ; Humans ; Lymph Nodes/*ultrasonography ; Lymphatic Metastasis/*diagnosis ; Retrospective Studies ; Sensitivity and Specificity ; Thyroglobulin/*metabolism ; Thyroid Neoplasms/*pathology ; Ultrasonography, Interventional

OBJECTIVETo determine the value of contrast ultrasound on evaluating tumor angiogenic activity and its prognostic value in axillary-node-negative breast carcinoma (ANNBC).

METHODSPower doppler imaging (PDI) was used to observe intratumoral vascularization before and post contrast agents injection. Intratumoral blood flow signals were measured and intratumoral vessel positive total areas (VPTA) were analyzed with computer-assisted quantitative assessment. Sections of malignant tumors were analyzed for the intratumoral microvessel density (MVD) by immunohistochemistry using monoclonal antibody to factor VIII-related antigen. The relationships within VPTA, MVD and prognosis were the main outcome measures.

RESULTSThere was no significant correlation between VPTA and MVD before contrast agents used while there was a positive correlation between them after that. However, VPTA and MVD had significant correlation with histology grade and tumor recurrence and metastasis while had no correlation with the general clinic pathologic factors. VPTA and MVD were significantly higher in postoperative cases with recurrence or metastasis than those in cases with tumor-free. Total survival rate and tumor-free survival rate of high-VPTA or high-MVD group were significantly lower than those of low-VPTA or low-MVD group.

CONCLUSIONSThe value of VPTA by contrast enhanced PDI was a beneficial prognostic indicator. High VPTA in ANNBC patients may has worse prognosis and antiangiogenic therapy is strongly suggested on them.

Adult ; Aged ; Axilla ; Breast Neoplasms ; blood supply ; diagnostic imaging ; metabolism ; Factor VIII ; analysis ; Female ; Follow-Up Studies ; Humans ; Image Enhancement ; Immunohistochemistry ; Lymph Nodes ; Middle Aged ; Neovascularization, Pathologic ; metabolism ; pathology ; Prognosis ; Survival Analysis ; Ultrasonography, Doppler ; methods