Nam Kyu Kim; Seong Joo Kang; Weon Hyoung Lee; Go Eun Yeo; You Jin Han; Bu Kyung Kim; Su Kyoung Kwon; Yo-Han Park; Young Sik Choi

doi:10.7180/kmj.2014.29.1.17

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Original Article Diagnostic Value of Preoperative Serum Thyroglobulin Measurement for the Diagnosis of Malignancy in Follicular or Hürthle Cell Neoplasms of the Thyroid Gland: Nam Kyu Kim, Seong Joo Kang, Weon Hyoung Lee, Go Eun Yeo, You Jin Han, Bu Kyung Kim, Su Kyoung Kwon, Yo-Han Park, Young Sik Choi; Kosin Medical Journal 2014;29(1):17-22.
DOI: https://doi.org/10.7180/kmj.2014.29.1.17
Published online: December 17, 2014

Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Young Sik Choi, Department of Internal Medicine, Kosin University College of Medicine, 34 Amnam dong, Seo-gu, Busan 602-702, Korea TEL: +82-51-990-6102 FAX: +82-51-248-5686 E-mail: yschoi@kosinmed.or.kr

• Received: June 4, 2013 • Revised: August 20, 2013 • Accepted: September 9, 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
References

Abstract

Objectives
The aim of this retrospective study was whether serum Tg predicts malignancy in follicular or Hürthle-cell neoplasms on fine needle aspiration.
Methods
A chart review of 111 patients (90 females, 21 males; mean age 46.8 ± 11.9 years) with follicular or Hürthle-cell neoplasms on fine needle aspiration, who were surgically treated between Sep. 2001 and Sep. 2011, was performed. Predictive factors for malignancy were identified by the chi-squared test and multivariate logistic regression.
Results
There were no differences between 41 malignant and 70 benign lesions in serum Tg or any of the normalized indexes. Receiver-operator characteristic analysis revealed no cutoff value. Lesions with serum Tg levels greater than 500 g/L had no significant difference. And also there were no independent predictors of malignancy by multivariate logistic regression.
Conclusions
In this study, the author found that serum Tg has poor accuracy for predicting malignancy in follicular or Hürthle cell neoplasms on fine needle aspiration.
Keywords: Follicular neoplasm; Hü; rthle cell neoplasm; Serum thyroglobulin; Thyroid carcinoma

Fig. 1.

Box plot comparison of serum thyroglobulin values between benign and malignant neoplasms with follicular or Hürthle cell neoplasm on fine needle aspiration.

Table 1.

Clinical characteristics of study subjects

	Total	FNA cytology		P-value
	Total	Follicular neoplasm	Hurthle cell neoplasm	P-value
Number of subjects (%)	111	98 (88.2%)	13 (11.8%)
Age (year)	46.8 ± 11.9	46.2 ± 12.0	50.9 ± 10.7	0.162
Sex ratio, female/male	90/21	79/19	11/2
TSH (mIU/L)	1.75 ± 1.52	1.59 ± 1.17	2.96 ± 2.86	0.112
Tg (μg/L)	166.2 ± 467.0	173.8 ± 494.1	110.4 ± 166.9	0.458
Nodule size (mm)	18.9 ± 15.7	19.5 ± 16.1	14.5 ± 12.4	0.277

Data were mean±SD, TSH, thyroid stimulating hormone; Tg, thyroglobulin.

Table 2.

Histologic diagnosis of study samples

	FNA diagnosis
	Follicular neoplasm n (%)	Hürthle cell neoplasm n (%)
Malignant	35 (100)	6 (100)
Papillary carcinoma	15 (42.9)	3 (50.0)
Follicular carcinoma	12 (34.3)	2 (33.3)
Medullary carcinoma	2 (5.7)	1 (16.7)
FV PC	2 (5.7)	0
PC with FC	4 (11.4)	0
Benign	63 (100)	7 (100)
Nodular hyperplasia(benign)	32 (50.8)	5 (71.4)
Follicular adenoma	27 (42.9)	1 (14.3)
Hürthle cell adenoma	1 (1.6)	1 (14.3)
Hashimoto's thyroiditis	2 (3.2)	0

FNA, fine needle aspiration; PC, papillary carcinoma; FC, follicular carcinoma; FV PC, follicular variant papillary carcinoma.

Table 3.

Comparison of malignant and benign histology groups

	Benign	Malignant	P-value
Number of subjects	70	41
Age (year)	47.0 ± 12.6	46.4 ± 10.9	0.797
TSH (mIU/L)	1.80 ± 1.67	1.67 ± 1.20	0.659
Tg (μg/L)	202.8 ± 571.1	101.3 ± 153.9	0.280
Nodule size (mm)	20.2 ± 14.1	16.7 ± 18.1	0.262
FNA results
Follicular neoplasm, n (%)	63 (64.3)	35 (35.7)	0.545
Hürthle cell adenoma, n (%)	7 (53.8)	6 (46.2)	0.545

Table 4.

Clinicopathologic parameters associated with malignant pathology in patients with follicular and Hürthle cell neoplasm on cytology

	Relative risk	95% CI	P-value
Male gender	1.070	0.398-2.876	0.893
Tumor size (≥ 4 cm)	0.834	0.241-2.887	0.774
Age ≥60	1.479	0.476-4.590	0.499

References

1. Vander JB, Gaston EA, Dawber TR. The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med 1968;69:537–40.Article PubMed
2. Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med 2004;351:1764–71.Article PubMed
3. Tan GH, Gharib H. Thyroid incidentalomas: Management approaches to nonpalpable nodules discovered incidentally on thyroid imaging. Ann Intern Med 1997;126:226–31.Article PubMed
4. Ezzat S, Sarti DA, Cain DR, Braunstein GD. Thyroid incidentalomas. Prevalence by palpation and ultrasonography. Arch Intern Med 1994;154:1838–40.Article PubMed
5. Mazzaferri EL. Management of a solitary thyroid nodule. N Engl J Med 1993;328:553–9.Article PubMed
6. Baloch ZW, Sack MJ, Yu GH, Livolsi VA, Gupta PK. Fine-needle aspiration of thyroid: an institutional experience. Thyroid 1998;8:565–9.Article PubMed
7. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71–96.Article PubMed
8. Jung KW, Won YJ, Park S, Kong HJ, Sung J, Shin HR, et al. Cancer statistics in Korea: incidence, motality and surival in 2005. J Korean Med Sci 2009;23:995–1003.
9. Sorrenti S, Trimboli P, Catania A, Ulisse S, De Antoni E, D'Armiento M. Comparison of malignancy rate in thyroid nodules with cytology of indeterminate follicular or indeterminate Hürthle cell neoplasm. Thyroid 2009;19:355–60.Article PubMed
10. Thoresen SO, Myking O, Glattre E, Rootwelt A, Foss OP. Serum thyroglobulin as a preclinical tumour marker in subgroups of thyroid cancer. Br J Cancer 1988;57:105–8.Article PubMed PMC
11. Petric R, Perhavec A, Gazic B, Besic N. Preoperative serum thyroglobulin concentration is an independent predictive factor of malignancy in follicular neoplasms of the thyroid gland. J Surg Oncol 2012;105:351–6.Article PubMed
12. Lin JD. Thyroglobulin and human thyroid cancer. Clin Chim Acta 2008;388:15–21.Article PubMed
13. Suh I, Vriens MR, Guerrero MA, Griffin A, Shen WT, Duh QY, et al. Serum thyroglobulin is a poor diagnostic biomarker of malignancy in follicular and Hurthle-cell neoplasms of the thyroid. Am J Surg 2010;200:41–6.PubMed
14. Cibas ES, Ali SZ. NCI Thyroid FNA State of the Science Conference. The Bethesda System for reporting thyroid cytopathology. Am J Clin Pathol 2009;132:658–65.Article PubMed
15. Castro MR, Gharib H. Thyroid fine-needle aspiration biopsy: progress, practice, and pitfalls. Endocr Pract 2003;9:128–36.Article PubMed
16. Cappelli C, Castellano M, Pirola I, Cumetti D, Agosti B, Gandossi E, et al. The predictive value of ultrasound findings in the management of thyroid nodules. QJM 2007;100:29–35.Article PubMed
17. Yim JH, Kim EY, Kim WG, Kim TY, Gong G, Hong SJ, et al. Postoperative Findings of the Cytological Diagnosis of Follicular Neoplasm or Hurthle Cell Neoplasm and the Risk of Malignancy. Endocrinol Metab 2010;25:316–20.Article
18. Herle AJ, Uller RP. Elevated serum thyroglobulin. A marker of metastases in differentiated thyroid carcinomas. J Clin Invest 1975;56:272–7.Article PubMed PMC
19. Black EG, Cassoni A, Gimlette TM, Harmer CL, Maisey MN, Oates GD, et al. Serum thyroglobulin in thyroid cancer. Lancet 1981;29:443–5.Article
20. Hrafnkelsson J, Tulinius H, Kjeld M, Sigvaldason H, Jónasson JG. Serum thyroglobulin as a risk factor for thyroid carcinoma. Acta Oncol 2000;39:973–7.Article PubMed
21. Hocevar M, Auersperg M. Role of serum thyroglobulin in the pre-operative evaluation of follicular thyroid tumours. Eur J Surg Oncol 1998;24:553–7.Article PubMed
22. Okamoto T, Kanbe M, Iihara M, Yamazaki K, Okamoto J, Yamashita T, et al. Measuring serum thyroglobulin in patients with follicular thyroid nodule: its diagnostic implications. Endocr J 1997;44:187–93.Article PubMed
23. Nikola Besic, Manja Sesek, Barbara Peric, Janez Zgajnar, Marko Hocevar. Predictive factors of carcinoma in 327 patients with follicular neoplasm of the thyroid. Med Sci Monit 2008;14:459–67.
24. Lee EK, Chung KW, Min HS, Kim TS, Kim TH, Ryu JS, et al. Preoperative serum thyroglobulin as a useful predictive marker to differentiate follicular thyroid cancer from benign nodules in indeterminate nodules. J Korean Med Sci 2012;27:1014–8.Article PubMed PMC
25. Yi Ka Hee, Park Young Joo, Koong Sung-Soo, Kim Jung-Han, Na Dong Gyu, Ryu Jin-Sook, et al. Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. Korean J Otolaryngol-Head Neck Surg 2011;54:8–36.Article

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Diagnostic Value of Preoperative Serum Thyroglobulin Measurement for the Diagnosis of Malignancy in Follicular or Hürthle Cell Neoplasms of the Thyroid Gland

Kosin Med J. 2014;29(1):17-22. Published online December 17, 2014

DOI: https://doi.org/10.7180/kmj.2014.29.1.17

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