Rendimiento diagnóstico de la detección de tiroglobulina del lavado de la aguja del aspirado de lesiones cervicales sospechosas de recidiva tumoral combinado con el BACAF en pacientes con antecedente de tiroidectomía total por cáncer de tiroides en un centro médico de la alta complejidad

Abstract

Background and objective: thyroid cancer is the most common endocrinological neoplasm
worldwide, within this diagnosis 90% corresponds to differentiated thyroid carcinoma (DTC)
whose recurrence at the cervical level after thyroidectomy occurs in 5-30% of cases. In the
post-surgical follow-up, cytological study by fine needle aspiration puncture (cyto-FNAF)
has been used to confirm the ultrasound findings suspicious of malignancy with a sensitivity
of 60% -85%.The aim of the study is to evaluate the diagnostic performance of thyroglobulin
detection of the ACAF needle wash combined with BACAF of cervical lesions suspicious
for tumor recurrence in patients thyroidectomized for thyroid cancer in comparison with the
pathological outcome of the surgical specimen. Patients and method: 30 patients were
included, all older than 18 years with a lesion ultrasonographically suspicious of tumor
recurrence (22 with ultrasonographic suspicion of lymph node metastasis and 8 with
recurrence of the surgical site). All 30 patients underwent surgical resection of the lesion and
histopathological study, a variable defined in our study as the Gold standard.The results of
the Tg detection of the FNA needle wash, CITO-PAAF were compared with the
histopathologic result of the surgical specimen. Results: of the 30 cases ultrasonographically
suspected of tumor recurrence 26 were true positive with a definite diagnosis of malignancy
with all FAT positive with values between 24.3ng/dl to > 5000 ng/ml. 1 false negative with
Tg FAT of 7.72 ng/ml (below the cut-off value of 10 ng/ml) for a papillary thyroid carcinoma
(PTC) metastasis. 3 true negatives with negative Tg FAT values <1.0 ng/ml, while the cyto-
FNA showed 23 true positives in synchrony with the definitive diagnosis of malignancy, 4
false negatives, 2 false positives and 1 true negative (benign), with a sensitivity and
specificity of 33% of the cyto-FNA.In the combined study of both diagnostic tests (FNA and
FNA cytology) in comparison with the Gold standard, it was observed that FNA Tg enhances
the diagnostic yield of FNA cytology. Conclusions: in patients with CDT and cervical
lesions ultrasonographically suspicious the FNA Tg improves the diagnostic yield of
cytological study. It was also demonstrated that the Tg FNA test alone, due to its high and
sufficient diagnostic yield, is sufficient for the early detection of tumor recurrence.

Date of Award	Dec 2022
Original language	Spanish (Colombia)
Awarding Institution	Universidad Autónoma de Bucaramanga Facultad de Ciencias de la Salud Especialización Médica y Quirúrgica en Radiología e Imágenes Diagnósticas
Supervisor	Oscar Fabian Valdivieso Cardenas (Supervisor) & Juan Carlos Alberto Uribe Caputi (Codirector)