Measurement of fine-needle aspiration thyroglobulin levels increases the detection of metastatic papillary thyroid carcinoma in cystic neck lesions

Brittany J. Holmes, Lori J. Sokoll, Qing Kay Li

Research output: Contribution to journalArticle


BACKGROUND: Patients with previously resected papillary thyroid carcinoma (PTC) are monitored for disease recurrence/ metastasis by ultrasound surveillance and fine-needle aspiration (FNA) cytology. However, accurate diagnosis in lesions with cystic degeneration may be difficult due to scant cellularity. In the current study, the authors evaluated thyroglobulin in FNA (Tg-FNA) for detecting metastatic and/or recurrent PTC in patients with cystic neck lesions after thyroidectomy. METHODS: The pathology records were retrospectively searched for patients with previously resected PTC and subsequent Tg-FNA on a cystic neck mass. Tg-FNA was measured in needle rinses using a Tg assay. The ultrasound findings, Tg-FNA concentrations, and cytological and follow-up histological diagnoses were correlated. RESULTS: A total of 21 FNA specimens of cystic lesions from 19 patients were identified. Of 7 cases with cytologic and subsequent histologic diagnoses of metastatic PTC, the median Tg-FNA level was 100,982 ng/mL. Of 8 cytologically benign cases, 7 cases had Tg-FNA levels<0.2 ng/mL, and 1 aberrant case demonstrated elevated Tg-FNA of>1000 ng/mL. For 6 cytologically equivocal cases, including 3 classified as atypical/suspicious for carcinoma, 2 classified as insufficient/acellular debris, and 1 classified as spindle cell neoplasm, 4 patients demonstrated markedly elevated Tg-FNA levels (> 150 ng/mL) with subsequent surgical confirmation of metastatic PTC, whereas 2 patients had Tg-FNA levels of<0.2 ng/mL with negative follow-up. Using a cutoff value of 0.2 ng/mL, Tg-FNA demonstrated a sensitivity of 100% and specificity of 87.5%. CONCLUSIONS: Tg-FNA is a useful ancillary test that improves the detection of cystic PTC metastases. Particularly in cytologically nondiagnostic cases, the measurement of Tg-FNA helps to distinguish benign from malignant cystic lesions.

Original languageEnglish (US)
Pages (from-to)521-526
Number of pages6
JournalCancer Cytopathology
Issue number7
StatePublished - Jul 2014


  • Cystic neck mass
  • Fine-needle aspirate
  • Metastatic papillary thyroid carcinoma
  • Thyroglobulin

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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