Rol de la dosificación de tiroglobulina en el líquido de lavado de la punción por aguja fina para el diagnóstico de metástasis ganglionares en el seguimiento de cáncer de tiroides en el Hospital de Clínicas de Montevideo, Uruguay
Palabras clave:
TIROGLOBULINA, CÁNCER TIROIDEO, PUNCIONES, ADENOPATÍAS
Resumen
La recurrencia del cáncer diferenciado de tiroides (CDT) a nivel del cuello ocurre en 5%-20% de los casos. El estudio citológico mediante punción de adenopatías ha sido utilizado para confirmar los hallazgos ecográficos sospechosos de malignidad, su sensibilidad varía entre 75%-85%.
El objetivo del estudio es evaluar la utilidad de la tiroglobulina (Tg) medida en la punción por aspiración de aguja fina (PAAF) (Tg-PAAF), en el diagnóstico de metástasis ganglionares de pacientes en seguimiento por CDT mayores de 18 años. Se realizó un estudio retrospectivo, descriptivo y observacional en una muestra de 14 pacientes predominantemente
de sexo femenino (71,4%), con edad promedio 40,9 ± 2,9 años.
Resultados: la variante CDT unifocal fue la más frecuente. De los 22 ganglios sospechosos la mitad tuvieron Tg-PAAF ≥ 1 ng/ml. Todas las adenitis reactivas tuvieron un resultado < 1 ng/ml, en cambio las adenopatías metastásicas obtuvieron un resultado ≥ 1 ng/ml. El 85,7% de pacientes tuvieron anticuerpos anti-Tg ≥10 UI/ml (5 pacientes con valores de
Tg-PAAF ≥1 ng/ml y siete pacientes con Tg-PAAF < 1 ng/ml) y 14,3% tuvieron valores < 10 UI/ml (todos con Tg-PAAF <1 ng/ml). Se realizaron cuatro vaciamientos ganglionares, en todas se encontró metástasis de CDT.
Conclusiones: la Tg-PAAF es un buen estudio para el diagnóstico de metástasis ganglionares en pacientes en seguimiento de CDT. Dado los resultados obtenidos en este trabajo, apoyado en la búsqueda bibliográfica, el uso de la Tg-PAAF tiene un gran valor diagnóstico para detectar metástasis ganglionares en el seguimiento del CDT por lo que se
recomienda su uso junto con la citología y/o la anatomía patológica.
Citas
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9) Rico-Morlán FJL, Hernández-Cuéllar A, Martínez-Macías R, Barra-Martínez R, Santiago-Vázquez RY. Niveles séricos de tiroglobulina como marcador de malignidad en pacientes con nódulo tiroideo. GAMO 2009; 8(2):54-61.
10) Harish K. Thyroglobulin: current status in differentiated thy¬roid carcinoma (review). Endocr Regul 2006; 40(2):53-67.
11) Tuttle R. Differentiated thyroid cancer: role of serum thy¬roglobulin. En: Shefner JM, ed. UpToDate. Waltham, MA: UpToDate, 2021. Disponible en: https://www.uptodate. com/contents/differentiated-thyroid-cancer-role-of-se¬rum-thyroglobulin?search=C%C3%A1ncer%20de%20tiroi¬des%20diferenciado&source=search_result&selectedTi-tle=4~150&usage_type=default&display_rank=4 [Consulta: 1º noviembre 2021].
12) Teres I, Astarita G, Mesch V, Mosquera Filoso G, Esteban MP, Kozac A, et al. Métodos de tiroglobulina de primera y segunda generación: su utilidad en pacientes con cáncer dif¬erenciado de tiroides. Rev Argent Endocrinol Metab 2017; 54(3):101-8. doi: 10.1016/j.raem.2017.05.002.
13) Spencer C, Fatemi S. Thyroglobulin antibody (TgAb) meth¬ods - Strengths, pitfalls and clinical utility for monitoring TgAb-positive patients with differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2013; 27(5):701-12. doi: 10.1016/j.beem.2013.07.003.
14) Boi F, Baghino G, Atzeni F, Lai ML, Faa G, Mariotti S. The diagnostic value for differentiated thyroid carcinoma metas¬tases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies. J Clin Endocrinol Metab 2006; 91(4):1364-9. doi: 10.1210/ jc.2005-1705.
15) Costante G, Filetti S. Diagnosis: thyroglobulin in fine-nee¬dle aspirates-a clue to metastasis? Nat Rev Endocrinol 2009; 5(5):249-50. doi: 10.1038/nrendo.2009.55.
16) Frasoldati A, Toschi E, Zini M, Flora M, Caroggio A, Dotti C, et al. Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid 1999; 9(2):105-11. doi: 10.1089/thy.1999.9.105.
17) Snozek CL, Chambers EP, Reading CC, Sebo TJ, Sistrunk JW, Singh RJ, et al. Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin En-docrinol Metab 2007; 92(11):4278-81. doi: 10.1210/jc.2007- 1075.
18) Cunha N, Rodrigues F, Curado F, Ilhéu O, Cruz C, Naidenov P, et al. Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: A technique for the diagnosis of met¬astatic differentiated thyroid cancer. Eur J Endocrinol 2007; 157(1):101-7. doi: 10.1530/EJE-07-0088.
19) Cignarelli M, Ambrosi A, Marino A, Lamacchia O, Cam¬po M, Picca G, et al. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic met¬astatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003; 13(12):1163-7. doi: 10.1089/10507250360731578.
20) Baskin HJ. Detection of recurrent papillary thyroid carcino¬ma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid 2004; 14(11):959-63. doi: 10.1089/thy.2004.14.959.
21) Sigstad E, Heilo A, Paus E, Holgersen K, Groholt KK, Jor¬gensen LH, et al. The usefulness of detecting thyroglobulin in fine-needle aspirates from patients with neck lesions us¬ing a sensitive thyroglobulin assay. Diagn Cytopathol 2007; 35(12):761-7. doi: 10.1002/dc.20726.
22) Duval da Silveira MA, Zanella AB, Cristo AP, Faccin CS, Graudenz MS, Maia AL. Impact of serum TSH and an¬ti-thyroglobulin antibody levels on lymph node fine-needle aspiration thyroglobulin measurements in differentiated thy¬roid cancer patients. Eur Thyroid J 2017; 6(6):292-7. doi: 10.1159/000479682.
23) Li J, Zhang K, Liu X, Hao F, Liu Z, Wang Z. Cervical lymph node thyroglobulin measurement in washout of fine-needle aspirates for diagnosis of papillary thyroid can¬cer metastases. Br J Biomed Sci 2016; 73(2):79-83. doi: 10.1080/09674845.2016.1173334.
24) Baldini E, Sorrenti S, Di Gioia C, De Vito C, Antonelli A, Gnessi L, et al. Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytolo¬gy? BMC Clin Pathol 2013; 13:7. doi: 10.1186/1472-6890- 13-7.
25) Salmaslioglu A, Erbil Y, Cıtlak G, Ersöz F, Sarı S, Olmez A, et al. Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary thyroid carcinoma. Langen¬becks Arch Surg 2011; 396(1):77-81. doi: 10.1007/s00423- 010-0723-1.
26) Aydin C, Ozdemir D, Sacikara M, Polat SB, Yazgan AK, Turkolmez S, et al. A new approach for standardization and increased accuracy of lymph node washout thyroglobulin in patients with differentiated thyroid carcinoma. Diagn Cyto¬pathol 2016; 44(3):177-86. doi: 10.1002/dc.23414.
2) M. Cecilia Martins-Costa1,2, Rui M. B. Maciel1,3,4, Tere¬sa S. Kasamatsu1, et al, Clinical impact of thyroglobulin (Tg) and Tg autoantibody (TgAb) measurements in needle washouts of neck lymph node biopsies in the management of patients with papillary thyroid carcinoma,vol - 61,DOI - 10.1590/2359-3997000000241,Archives of Endocrinology and Metabolism
3) Konca Degertekin C, Yalcin MM, Cerit T, Ozkan C, Kalan I, Iyidir OT, et al. Lymph node fine-needle aspiration washout thyroglobulin in papillary thyroid cancer: diagnostic value and the effect of thyroglobulin antibodies. Endocr Res 2016; 41(4):281-9. doi: 10.3109/07435800.2016.1141936.
4) Lee JH, Lee HC, Yi HW, Kim BK, Bae SY, Lee SK, et al. Influence of thyroid gland status on the thyroglobulin cutoff level in washout fluid from cervical lymph nodes of patients with recurrent/metastatic papillary thyroid cancer. Head Neck 2016; 38(Suppl 1):E1705-12. Disponible en: https:// pubmed.ncbi.nlm.nih.gov/26614648/ [Consulta: 12 abril 2021]. doi: 10.1002/hed.24305.
5) Al-Hilli Z, Strajina V, McKenzie TJ, Thompson GB, Farley DR, Regina Castro M, et al. Thyroglobulin measurement in fine-needle aspiration improves the diagnosis of cervical lymph node metastases in papillary thyroid carcinoma. Ann Surg Oncol 2017; 24(3):739-44. doi: 10.1245/s10434-016- 5625-1.
6) Pacini F, Fugazzola L, Lippi F, Ceccarelli C, Centoni R, Mic¬coli P, et al. Detection of thyroglobulin in fine needle aspi¬rates of nonthyroidal neck masses: a clue to the diagnosis of metastatic differentiated thyroid cancer. J Clin Endocrinol Metab 1992; 74(6):1401-4. Disponible en: https://pubmed. ncbi.nlm.nih.gov/1592886/ [Consulta: 15 agosto 2021] doi: 10.1210/jcem.74.6.1592886.
7) Tuttle R. Didderentiated thyroid cancer: overview of management. En: Shefner JM, ed. UpToDate. Waltham, MA: UpToDate, 2022. Disponible en: https://www.up¬todate.com/contents/differentiated-thyroid-cancer-over¬view-of-management?search=C%C3%A1ncer%20de%20 tiroides%20diferenciado&source=search_result&selected-Title=1~150&usage_type=default&display_rank=1 [Con¬sulta:1º noviembre 2021].
8) Pitoia F, Califano I, Vázquez A, Faure E, Gauna A, Orlandi A, et al. Consenso intersocietario∗ sobre tratamiento y se-guimiento de pacientes con cáncer diferenciado de tiroides. Rev Argent Endocrinol Metab 2014; 51(2):85-118.
9) Rico-Morlán FJL, Hernández-Cuéllar A, Martínez-Macías R, Barra-Martínez R, Santiago-Vázquez RY. Niveles séricos de tiroglobulina como marcador de malignidad en pacientes con nódulo tiroideo. GAMO 2009; 8(2):54-61.
10) Harish K. Thyroglobulin: current status in differentiated thy¬roid carcinoma (review). Endocr Regul 2006; 40(2):53-67.
11) Tuttle R. Differentiated thyroid cancer: role of serum thy¬roglobulin. En: Shefner JM, ed. UpToDate. Waltham, MA: UpToDate, 2021. Disponible en: https://www.uptodate. com/contents/differentiated-thyroid-cancer-role-of-se¬rum-thyroglobulin?search=C%C3%A1ncer%20de%20tiroi¬des%20diferenciado&source=search_result&selectedTi-tle=4~150&usage_type=default&display_rank=4 [Consulta: 1º noviembre 2021].
12) Teres I, Astarita G, Mesch V, Mosquera Filoso G, Esteban MP, Kozac A, et al. Métodos de tiroglobulina de primera y segunda generación: su utilidad en pacientes con cáncer dif¬erenciado de tiroides. Rev Argent Endocrinol Metab 2017; 54(3):101-8. doi: 10.1016/j.raem.2017.05.002.
13) Spencer C, Fatemi S. Thyroglobulin antibody (TgAb) meth¬ods - Strengths, pitfalls and clinical utility for monitoring TgAb-positive patients with differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2013; 27(5):701-12. doi: 10.1016/j.beem.2013.07.003.
14) Boi F, Baghino G, Atzeni F, Lai ML, Faa G, Mariotti S. The diagnostic value for differentiated thyroid carcinoma metas¬tases of thyroglobulin (Tg) measurement in washout fluid from fine-needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies. J Clin Endocrinol Metab 2006; 91(4):1364-9. doi: 10.1210/ jc.2005-1705.
15) Costante G, Filetti S. Diagnosis: thyroglobulin in fine-nee¬dle aspirates-a clue to metastasis? Nat Rev Endocrinol 2009; 5(5):249-50. doi: 10.1038/nrendo.2009.55.
16) Frasoldati A, Toschi E, Zini M, Flora M, Caroggio A, Dotti C, et al. Role of thyroglobulin measurement in fine-needle aspiration biopsies of cervical lymph nodes in patients with differentiated thyroid cancer. Thyroid 1999; 9(2):105-11. doi: 10.1089/thy.1999.9.105.
17) Snozek CL, Chambers EP, Reading CC, Sebo TJ, Sistrunk JW, Singh RJ, et al. Serum thyroglobulin, high-resolution ultrasound, and lymph node thyroglobulin in diagnosis of differentiated thyroid carcinoma nodal metastases. J Clin En-docrinol Metab 2007; 92(11):4278-81. doi: 10.1210/jc.2007- 1075.
18) Cunha N, Rodrigues F, Curado F, Ilhéu O, Cruz C, Naidenov P, et al. Thyroglobulin detection in fine-needle aspirates of cervical lymph nodes: A technique for the diagnosis of met¬astatic differentiated thyroid cancer. Eur J Endocrinol 2007; 157(1):101-7. doi: 10.1530/EJE-07-0088.
19) Cignarelli M, Ambrosi A, Marino A, Lamacchia O, Cam¬po M, Picca G, et al. Diagnostic utility of thyroglobulin detection in fine-needle aspiration of cervical cystic met¬astatic lymph nodes from papillary thyroid cancer with negative cytology. Thyroid 2003; 13(12):1163-7. doi: 10.1089/10507250360731578.
20) Baskin HJ. Detection of recurrent papillary thyroid carcino¬ma by thyroglobulin assessment in the needle washout after fine-needle aspiration of suspicious lymph nodes. Thyroid 2004; 14(11):959-63. doi: 10.1089/thy.2004.14.959.
21) Sigstad E, Heilo A, Paus E, Holgersen K, Groholt KK, Jor¬gensen LH, et al. The usefulness of detecting thyroglobulin in fine-needle aspirates from patients with neck lesions us¬ing a sensitive thyroglobulin assay. Diagn Cytopathol 2007; 35(12):761-7. doi: 10.1002/dc.20726.
22) Duval da Silveira MA, Zanella AB, Cristo AP, Faccin CS, Graudenz MS, Maia AL. Impact of serum TSH and an¬ti-thyroglobulin antibody levels on lymph node fine-needle aspiration thyroglobulin measurements in differentiated thy¬roid cancer patients. Eur Thyroid J 2017; 6(6):292-7. doi: 10.1159/000479682.
23) Li J, Zhang K, Liu X, Hao F, Liu Z, Wang Z. Cervical lymph node thyroglobulin measurement in washout of fine-needle aspirates for diagnosis of papillary thyroid can¬cer metastases. Br J Biomed Sci 2016; 73(2):79-83. doi: 10.1080/09674845.2016.1173334.
24) Baldini E, Sorrenti S, Di Gioia C, De Vito C, Antonelli A, Gnessi L, et al. Cervical lymph node metastases from thyroid cancer: does thyroglobulin and calcitonin measurement in fine needle aspirates improve the diagnostic value of cytolo¬gy? BMC Clin Pathol 2013; 13:7. doi: 10.1186/1472-6890- 13-7.
25) Salmaslioglu A, Erbil Y, Cıtlak G, Ersöz F, Sarı S, Olmez A, et al. Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary thyroid carcinoma. Langen¬becks Arch Surg 2011; 396(1):77-81. doi: 10.1007/s00423- 010-0723-1.
26) Aydin C, Ozdemir D, Sacikara M, Polat SB, Yazgan AK, Turkolmez S, et al. A new approach for standardization and increased accuracy of lymph node washout thyroglobulin in patients with differentiated thyroid carcinoma. Diagn Cyto¬pathol 2016; 44(3):177-86. doi: 10.1002/dc.23414.
Publicado
2022-10-12
Cómo citar
1.
Pritsch C, Finozzi R, Neira N. Rol de la dosificación de tiroglobulina en el líquido de lavado de la punción por aguja fina para el diagnóstico de metástasis ganglionares en el seguimiento de cáncer de tiroides en el Hospital de Clínicas de Montevideo, Uruguay. Rev. Méd. Urug. [Internet]. 12 de octubre de 2022 [citado 17 de noviembre de 2024];38(3):e38302. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/894
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