Application and evaluation of fine needle aspiration biopsy and eluate detection for cervical lymph node dissection decision in patients with thyroid carcinoma

doi:10.19538/j.cjps.issn1005-2208.2017.09.16

Abstract：Objective To investigate the value of ultrasound-guided fine needle aspiration biopsy and technology of elution detection in strategy of cervical lymph node dissection in thyroid cancer patients.Methods The retrospective study included all thyroid papillary carcinoma patients who underwent primary surgical treatment in Department of Thyroid Surgery China-Japan Union Hospital from January 2013 to May 2017.The patients who received both fine needle aspiration cytology (FNAC)and thyroglobulin detection in eluate (FNA-Tg) were further analyzed.The diagnostic results of the above mentioned were compared with preoperative ultrasound image and postoperative paraffin pathology,and some health economics indexes were also analyzed.Results Totally 9923 patients were enrolled in the study,of whom 2609 patients were evaluated by ultrasound guided combined FNAC and FNA-Tg (FNAC-Tg),and then 254 patients among them underwent lateral cervical lymph node dissection and paraffin pathological examination.For the diagnosis of the lateral cervical lymph node,the sensitivity,specificity and accuracy of ultrasonography and FNAC-Tg were 67.57％ vs.97.30％,71.01％ vs.82.61％ and 68.38％ vs.93.81％,respectively.No neck hematoma,postoperative infection or needle-related metastasis occurred.The average hospitalization days of patients performed operation were 7.9,7.3,7.0,6.5,6.3 days each year from 2013 to 2017.The lateral cervical lymph node dissection accounted for the proportion of patients were 52.6％,34.2％,30.8％,14.7％,12.4％,respectively.Lymph node metastasis rate in lateral cervical lymph node dissection samples were 35.8％,67.1％,60.4％,78.0％,80.1％,respectively.Conclusion The combination of FNAC and FNA-Tg can increase the diagnostic accuracy of lymph node metastasis in thyroid carcinoma.It provides strong basis of evidence-based medicine for the development of the strategy of lateral cervical lymph node dissection,which is helpful to reduce the proportion of prophylactic lateral cervical lymph node dissection and then save medical resources.