Intraoperative measurement of thyroglobulin in lymph node aspirates for the detection of metastatic papillary thyroid carcinoma

Exploring the mechanism of vitamin C on the co-expressed genes of papillary thyroid carcinoma and Epstein-Barr virus based on bioinformatics, network pharmacology and molecular docking analysis

OBJECTIVE

The study aims to evaluate the role and mechanism of action of vitamin C as an anti- Epstein-Barr virus (EBV) and papillary thyroid carcinoma (PTC) therapeutic agent.

METHODS

The PTC/EBV-associated genes were obtained by intersection and further screen out hub genes to construct a prognostic model. The relationship between PTC/EBV-related genes and core genes and immune infiltration was analyzed, respectively. Finally, the core targets of vitamin C against PTC/EBV were screened, and the binding sites were determined by molecular docking with vitamin C.

RESULTS

The diagnostic efficiency and prognostic value of this model was good. The prognostic model performed well in male, female, classical, T3-4, N0, and N1 subgroups. Core genes STAT1 and APOE were highly expressed and FGF7 was lowly expressed in PTC. The core genes STAT1, APOE and FGF7 were significantly correlated with a variety of immune cells. 263 vitamin C-related targets were screened by the database, and 11 cross genes between vitamin C and PTC/EBV were identified. 4 molecular targets with the best performance, LGALS3, MMP9, CTSB and CTSS, were identified by topological analysis, and the binding energies were all <  -5.0 kcal/mol.

CONCLUSIONS

Our prognostic model has good diagnostic and prognostic effects and has potential value of basic research. This study for the first time revealed the related molecular functions of vitamin C and the molecular targets for the treatment of PTC/EBV.

Detection of Central Compartment Lymph Node Metastasis of Thyroid Cancer: Usefulness of Intraoperative Thyroglobulin Measurement in Fine Needle Aspiration Washout with and Without Blue Dye Injection

Background/Objectives: The management of lymph node metastases of the central neck compartment (CNC) in differentiated thyroid carcinoma is debated. The intraoperative measurement of thyroglobulin (Tg) has gained attention in accurately detecting metastases, reducing unnecessary CNC dissections. Methods: A total of 37 patients underwent surgery. An intraoperative assay of thyroglobulin from fine needle aspiration (Tg-FNA) was performed on CNC lymph nodes, identified by blue dye injection in 15 patients (23 nodes, group A) and by palpation in 22 patients (35 nodes, group B). The Tg-FNA values were compared with histology to calculate the diagnostic accuracy. Results: In group A, the blue dye diffused widely, complicating lymph node identification: 2 were metastatic and 21 non-metastatic, with median Tg-FNA levels of 6236 ng/mL and 99.20 ng/mL, respectively. In group B, 8 were metastatic and 27 benign, with median Tg-FNA levels of 4063 ng/mL and 121 ng/mL (p < 0.0001), respectively. ROC analysis identified 500 ng/mL as a cutoff, achieving 100% sensitivity and 74% specificity in group B and 90% sensitivity and 70% specificity overall. Finally, among the non-metastatic lymph nodes, group A exhibited some cases of very high Tg-FNA values compared to group B, with lower accuracy for the cutoff, suggesting that colorant injection might lead to increased Tg-FNA levels. Conclusions: Blue dye injection showed low accuracy. Intraoperative Tg-FNA was reliable in detecting CNC metastases, although a higher cutoff is needed in this compartment compared to what has been reported for lateral lymph nodes. Lymphatic drainage and surgical manipulation might explain these findings. The careful interpretation of Tg-FNA in CNC should be adopted.

The diagnostic value of GICA used for intraoperative lymph node FNA-Tg measurement to evaluate thyroid cancer metastases

Objective

It is crucial to diagnose lymph node (LN) metastases (LNM) before or during thyroid carcinoma surgery. Measurement of thyroglobulin (Tg) in the fine needle aspirate washout (FNA-Tg) is useful to assist in the diagnosis of LNM for papillary thyroid carcinoma (PTC). This study aimed to assess the diagnostic performance of a new technique based on a colloidal gold-based immunochromatographic assay (GICA) for intraoperative FNA-Tg in diagnosing LNM.

Clinical trial information

This study is registered with chictr.org.cn, ID: ChiCTR2200063561 (registered 11 September, 2022).

Methods

This prospective study enrolled 51 PTC patients who underwent cervical LN dissection. A total of 150 LNs dissected from the central and lateral compartments were evaluated by FNA-Tg-GICA at three different time points and compared with frozen sections and the conventional Tg measurement method electrochemiluminescence immunoassay (ECLIA). Receiver operating characteristic curve (ROC) and area under the curve (AUC), cutoff value to discriminate benign and malignant LNs, sensitivity, specificity, and accuracy were provided.

Results

The cutoff value of FNA-Tg to predict LNM was 110.83 ng/mL for ECLIA and 13.19 ng/mL, 38.69 ng/mL, and 77.17 ng/mL for GICA at 3, 10, and 15 min, respectively. There was no significant difference between the AUCs of GICA at different time points compared to using ECLIA and frozen sections. Besides, the diagnostic performance of GICA and ECLIA showed no significant difference in evaluating LNM from central and lateral compartments or between the TgAb-positive subgroup and TgAb-negative subgroup.

Conclusion

GICA is a promising method for intraoperative FNA-Tg measurement and has high value in predicting LNM. It may be a novel alternative or supplementary method to frozen section or ECLIA.

Lymph node thyroglobulin in the diagnosis of metastases of thyroid carcinoma with the thyroid in situ: A prospective intraoperative study

BACKGROUND

The use of thyroglobulin concentration in washout fluid of fine-needle aspiration (FNA-Tg) is a procedure advocated by international guidelines to diagnose metastatic LN in papillary thyroid cancer. With the increasing use of active follow-up or lobectomy alone for low-risk thyroid cancers, the determination of the diagnostic performance of FNA-Tg in the detection of metastatic PTC when the thyroid is in situ is paramount.

MATERIALS AND METHODS

Prospective study with measurement of Tg in washout fluid obtained from intraoperative fine needle aspiration (FNA) cytology in order to avoid contamination from thyroid tissue and rigorously isolated punctured nodes. Receiver-operating characteristic (ROC) curve and area under the curve (AUC), optimal threshold to discriminate benign and malignant LN, sensitivity and specificity were provided.

RESULTS

a total of 58 lymph nodes from 32 patients were analyzed. ROC analysis defined the optimal cutoff values of FNA-Tg at 60 ng/ml for the diagnosis of malignant LNs in patients with a thyroid in situ. Sensitivity and specificity were 75% (95% confidence interval 57.89-86.75) and 87.5% (95%CI: 69-95.66), respectively.

CONCLUSION

Our results support the hypothesis that the Tg-FNA threshold for a safe diagnosis of LN metastasis in PTC is higher in presence of a thyroid gland in situ. The use of lower thresholds could result in false positive results and lead to unnecessary surgery.