Preoperative Serum Thyroglobulin as a Useful Predictive Marker to Differentiate Follicular Thyroid Cancer from Benign Nodules in Indeterminate Nodules
이은경, 정기욱, 민혜숙, 김태성, 김태현, 류준선, 정유석, 김석기, 이유진,
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이은경 ( Lee Eun-Kyung )
National Cancer Center Department of Internal Medicine
정기욱 ( Chung Ki-Wook )
National Cancer Center Research Institute and Hospital Center for Thyroid Cancer
민혜숙 ( Min Hye-Sook )
National Cancer Center Department of Internal Medicine
김태성 ( Kim Tae-Sung )
National Cancer Center Department of Internal Medicine
김태현 ( Kim Tae-Hyun )
National Cancer Center Department of Internal Medicine
류준선 ( Ryu Jun-Sun )
National Cancer Center Center for Thyroid Cancer
정유석 ( Jung Yoo-Seok )
National Cancer Center Department of Internal Medicine
김석기 ( Kim Seok-Ki )
National Cancer Center Department of Internal Medicine
이유진 ( Lee You-Jin )
National Cancer Center Center for Thyroid Cancer
KMID : 0191120120270091014
Abstract
Indeterminate cytology results increase the number of repetitive procedure and unnecessary surgery. This study was designed to find useful and simple predictive tools to differentiate malignant thyroid nodules from indeterminate nodules. We retrospectively enrolled 164 patients who had undergone thyroid surgery as a result of indeterminate cytology in the National Cancer Center. We reviewed patients' age at diagnosis, sex, preoperative biochemical markers such as thyroglobulin (Tg), anti-Tg antibody, free T4 and TSH level, and sonographical and pathological findings, which were subjected to statistical analysis. We found several clinical and sonographical predictive factors that showed significant differences. Young age, male, preoperative high Tg level, and hypoechoic nodule on sonography all increased cancer probability significantly in multivariate analysis. With a cut-off value of 187.5 ng/mL Tg, sensitivity and specificity were 54.8% and 90.1%, respectively (AUC 0.748, P < 0.001). In the case of nodule size > 1.7 cm, elevated serum Tg predicts the risk of malignancy; especially Tg > 70 ng/mL (odds ratio 3.245, 95% confidence interval 1.115-9.450, P = 0.038). Preoperative Tg levels had very high specificity in predicting thyroid cancer in case of suspicious follicular neoplasm. Therefore, Tg levels may be a useful marker for differentiating thyroid cancer from benign thyroid nodules in the cytological diagnosis of indeterminate nodules.
키워드
Thyroid Nodule; Fine Needle Aspiration; Thyroglobulin
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