Utilidad de la tiroglobulina en lavado de aguja y citología ganglionar en cáncer de tiroides metastásico
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Antecedentes: La tiroglobulina en lavado de aguja, y la citología por punción aspiración
con aguja fina de los ganglios linfáticos son dos métodos para confirmar metástasis
locorregional del Cáncer Diferenciado de Tiroides. Objetivo general: Determinar la
utilidad de la tiroglobulina en lavado de aguja y la citología ganglionar en el diagnóstico del
Cáncer Diferenciado de Tiroides metastásico. Metodología: Es un estudio de tipo
descriptivo, correlacional, diseño no experimental, cuantitativo, de corte transversal. Se
calculó la sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo,
precisión de la tiroglobulina en lavado de aguja, de la citología y la combinación de las dos
pruebas. Resultados: Se incluyeron 102 ganglios linfáticos de 83 pacientes con cáncer de
tiroides. Los resultados mostraron que 65 ganglios fueron malignos, y 37 benignos. La
combinación de la tiroglobulina en lavado de aguja + la citología obtuvo mejor sensibilidad
(83%), que cada una de las pruebas solas (tiroglobulina en lavado de aguja 78%, citología
75%). La tiroglobulina en lavado de aguja fue más específica (100%) vs la citología (94%)
y la combinación de los dos métodos (86%). El mejor punto de corte de la tiroglobulina por
PAAF fue de 4.33 ng/ml, con una sensibilidad 99%, y especificidad 84,62%, área bajo la
curva 0,935 (IC del 95%: 0,887-0,983; p valor significativo < 0,05 igual a 3,25x10-13).
Conclusiones: La combinación de las dos pruebas aporta mayor sensibilidad para la
detección de las metástasis locorregionales, mientras que la tiroglobulina en lavado de aguja
es más específica que la citología para determinar metástasis.
Background: Thyroglobulin fine needle aspiration (FNA-Tg) and fine needle aspiration cytology (FNAC) of lymph nodes are two methods for confirming lymph node metastases (LNM) in patients with differentiated thyroid carcinoma (DTC). Objetives: To determine the usefulness of FNA-Tg and FNAC in the diagnosis of metastatic Differentiated Thyroid Carcinoma. Methods: A descriptive, correlational, non-experimental, quantitative, crosssectional study was conducted. The sensitivity, specificity, positive predictive value, negative predictive value, precision / accuracy of FNA-Tg, FNAC, and the combination of the two tests were calculated. Using a ROC curve, the best cutoff point for FNA-Tg was determined to predict metastases. Results: 102 lymph nodes from 83 patients with suspicious locoregional metastases were included. The results showed that 65 lymph nodes were diagnosed as malignant, and 37 were benign. The combination of FNA-Tg and FNAC showed greater sensitivity (83%) than each alone (FNA-Tg 78%, cytology 75%). FNA-Tg was more specific (100%) than cytology (94%) and, the combination of FNAC and FNATg (86%). The best cut-off value of FNA-Tg to differentiate malignant lymph nodes benign from from benign was 4.33 ng / ml, with a sensitivity of 99%, and specificity of 84.62%. A area under the curve was 0.935 (CI 95 %: 0.887-0.983; p significant value <0.05 equal to 3.25x10-13). Conclusions: The combination of FNAC and FNA-Tg is more sensitive for detecting locoregional metastases.FNA-Tg is more specific at detecting non-metastatic nodes than cytology.
Background: Thyroglobulin fine needle aspiration (FNA-Tg) and fine needle aspiration cytology (FNAC) of lymph nodes are two methods for confirming lymph node metastases (LNM) in patients with differentiated thyroid carcinoma (DTC). Objetives: To determine the usefulness of FNA-Tg and FNAC in the diagnosis of metastatic Differentiated Thyroid Carcinoma. Methods: A descriptive, correlational, non-experimental, quantitative, crosssectional study was conducted. The sensitivity, specificity, positive predictive value, negative predictive value, precision / accuracy of FNA-Tg, FNAC, and the combination of the two tests were calculated. Using a ROC curve, the best cutoff point for FNA-Tg was determined to predict metastases. Results: 102 lymph nodes from 83 patients with suspicious locoregional metastases were included. The results showed that 65 lymph nodes were diagnosed as malignant, and 37 were benign. The combination of FNA-Tg and FNAC showed greater sensitivity (83%) than each alone (FNA-Tg 78%, cytology 75%). FNA-Tg was more specific (100%) than cytology (94%) and, the combination of FNAC and FNATg (86%). The best cut-off value of FNA-Tg to differentiate malignant lymph nodes benign from from benign was 4.33 ng / ml, with a sensitivity of 99%, and specificity of 84.62%. A area under the curve was 0.935 (CI 95 %: 0.887-0.983; p significant value <0.05 equal to 3.25x10-13). Conclusions: The combination of FNAC and FNA-Tg is more sensitive for detecting locoregional metastases.FNA-Tg is more specific at detecting non-metastatic nodes than cytology.
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Tiroglobulina, Citología ganglionar, Lavado de aguja, Neoplasias de la tiroides, Epidemiología descriptiva, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador