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ORIGINAL ARTICLE
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Assessment of preoperative thyroglobulin levels in papillary thyroid cancer


1 General Surgery, Kilis State Hospital, Kilis, Turkey
2 Department of General Surgery, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey

Date of Submission29-Aug-2020
Date of Decision02-Sep-2020
Date of Acceptance12-Jan-2021
Date of Web Publication24-Jul-2021

Correspondence Address:
Mehmet Ali Melik,
Kilis State Hospital, Kilis
Turkey
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_1268_20

 > Abstract 


Background: The papillary thyroid cancers (PTCs) are the most common cancer of endocrine cancers. The primary treatment is surgery, and the prognosis is mostly well. In spite of many methods for the early diagnosis, the simpler and noninvasive methods are being sought. The aim of this study is to find out whether the value of thyroglobulin (Tg) is related with PTC.
Materials and Methods: Prospectively; we measured the preoperative Tg value of 203 (159 females and 44 males) patients who underwent a total thyroidectomy with various indications in General Surgery Department of Gaziantep University. Tg values of 61 patients with benign lesions and 142 patients with PTC were compared.
Results: In the patients with PTC, the mean preoperative Tg value was 105.05 ng/ml and 76.80 ng/ml in the benign patients. According to receiver operating characteristic analysis, the cutoff point was determined 102 ng/ml. There was a statistically significant difference in preoperative Tg values between benign group and PTC (P < 0.05).
Conclusion: Patients with a preoperative Tg values above 102 ng/mL may more likely to have PTC. It is thought that Tg levels may be accepted as a criterion for distinguish malignant/benign situations that should be supported with new studies.

Keywords: Papillary thyroid cancers, thyroglobulin, thyroid



How to cite this URL:
Melik MA, Baskonus I, Yilmaz L. Assessment of preoperative thyroglobulin levels in papillary thyroid cancer. J Can Res Ther [Epub ahead of print] [cited 2021 Nov 29]. Available from: https://www.cancerjournal.net/preprintarticle.asp?id=322269




 > Introduction Top


The most common malignancy of endocrine system is thyroid cancers. Thyroid cancers develop from epithelial and nonepithelial parts of thyroid tissue. Papillary, follicular, and anaplastic type thyroid cancers originate from the follicular epithelium of the thyroid. Other thyroid cancers are the medullary thyroid cancer, primary lymphoma, sarcoma, and metastases.[1],[2] In differentiated thyroid carcinoma, 49% of all metastases are lung metastases, 24% are bone metastases, 19% are diffuse metastases, and 8% are solitary other organ metastases. Apart from these, multiple endocrine neoplasia and isolated familial medullary thyroid cancers may be also seen.[3]

Papillary thyroid cancer (PTC) is the most common (80%) type among thyroid cancers. In all age groups, except childhood, thyroid cancers are three times more common in women than men.[4]

In the evaluation of papillary thyroid neoplasms for distinguish benign or malignant, thyroglobulin (Tg) levels can be measured in peripheral blood. Tg level is valuable in detecting local or metastatic recurrence after total thyroidectomy in well-differentiated thyroid carcinomas.[4] Tg measurement is a sensitive biochemical method in determining persistent tumor and used routinely in the follow-up of PTC.

Tg takes a role in the conversion of MIT and DIT to T3 and T4. During this procedure, Tg leaks into the peripheral blood circulation. The level of Tg which leaks to the peripheral blood circulation during this process is measured.[4]

In the study, we aimed to show the correlation of preoperative Tg levels between patients who underwent thyroidectomy for PTC and for other benign thyroid diseases.


 > Materials and Methods Top


Patients operated between September 2016 and December 2017 as a result of XXX University Surgery-Endocrine Council decision were included in the study. The patients were who had malignant/suspicious fine-needle aspiration biopsy results, toxic goiter, and symptoms of compression.

The patients were informed about the study before the operation and their informed consent was obtained.

Patients' age, gender, additional diseases, and whether they were exposed to radiation were recorded. Patients' Tg levels were measured from blood 1 day before the surgery. Total thyroidectomy was performed to the patients.

After the pathology results of the patients who underwent preoperative Tg measurement and then total thyroidectomy were screened, 142 patients who were diagnosed with PTC were included. Patients with the same conditions but without a pathological diagnosis of malignancy were included as the control group. One hundred and forty-two patients with papillary thyroid carcinoma from the malignant group were selected. This group was classified according to histological subtype, tumor diameter, and capsule presence. Sixty-one patients with benign pathology results were also determined as the control group. Preoperative Tg levels and pathology results of patients were compared.

Statistical analysis

Shapiro–Wilk test, Student's t-test, Mann–Whitney U–test, Kruskal–Wallis test, and Chi-square test were used to evaluate the data. Multiple binary logistic regression analysis was performed, and the effect of age was resolved in investigating the relationship between preoperative Tg values and malignancy. IBM SPSS Statistics 22.0 version program New York, United States, was used for statistical analysis and P < 0.05 was considered statistically significant.


 > Results Top


The preoperative Tg value was found 105.05 ng/ml in the PTC group and 76.80 ng/ml in the control group. 102 ng/ml value was calculated as the cutoff point by receiver operating characteristic (ROC) analysis. The distribution of age-related Tg values was calculated, and there was a significant difference [Table 1].
Table 1: Distribution of papillary thyroid cancers and benign patients by age

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Serum Tg level was measured as 76.80 ng/ml in benign group and 105.05 ng/ml in patients with PTC [Table 2]. A significant difference was observed between the preoperative Tg values of PTC and benign group (P < 0.05) [Figure 1].
Table 2: Preoperative thyroglobulin values

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Figure 1: Preoperative thyroglobulin values between papillary thyroid cancers and benign group

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With the ROC curve, the cut point was tried to determine for distinguishing PTC and control group [Figure 2]. The cutoff point was found as 102 ng/ml. The specificity was 68.85, and the sensitivity was 50.00.
Figure 2: Comparison of preoperative thyroglobulin values with receiver operating characteristic curve

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 > Discussion Top


In a study conducted by Petric et al. in 2011, similar to our study, it was shown that preoperative Tg levels were higher in PTC than benign groups.[5] It was concluded that this could be an independent parameter to reduce complementary thyroidectomy operations.

According to the study conducted by Lee et al. in 2012 with 800 case series, malignant patients' Tg levels are significantly higher.[6] In this study, even a cutoff point (188 ng/ml) was determined for follicular carcinoma. Although PTC has not been studied in this study, the high Tg levels of malignant patients are a supportive result for our study. Although this study provides superiority to our research because of the case number, our research is more specific because it is for papillary cancer.

In 2014, Oltmann et al. stated that the preoperative Tg value may be an important factor in determining metastatic thyroid cancers.[7] Although the method of this long-term retrospective study is different, it is similar to our research in terms of its results.

In the study involving McGill scoring by Scheffler et al., the probability of the thyroid nodule to be malignant was tried to be determined.[8],[9] Moreover, the inclusion of the preoperative Tg levels in scoring has been shown to increase the sensitivity of scoring. This result also supports our study.

In 2014, Rinaldi et al. conducted a study on 1124 patients and found that preoperative Tg level was higher in malignant patients therewithal concluded that it was more significant in the follicular carcinoma group than papillary carcinomas.[10] Although it provides superiority, it supports our study.

In 2017, Kim et al. in a study especially on distant metastases, they found different Tg levels on lung and bone metastases and showed that preoperative Tg levels may be used for staging in papillary and follicular carcinomas.[11] These results also support our research, and even because our research is prospective, it provides superiority to this research.

It is stated in the one of the widest compilations made by Trimboli et al. which includes 3500 cases and 13 studies, that the only preoperative Tg values may fail to distinguish benign/malignant.[12] However, they also stated that Tg may be an indicator of malignancy. This study, which seems to be similar to our research, has been a valuable support to our research with the high number of cases.

Eventually, the preoperative Tg levels were found significantly higher in papillary thyroid carcinomas. In the light of all these studies, we try to emphasize the importance of preoperative Tg values.


 > Conclusion Top


As a result, it was concluded that preoperative serum Tg levels may be useful for distinguishing malignant-benign situations, and in this way, secondary operations may not be required in malignant patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Beauchamp D, Evers B.Mark, Mattox KL. Sabiston Textbook of Surgery. 17th ed. Elsevier Saunders 2004. p. 947 83.  Back to cited text no. 1
    
2.
Rahman GA. Extent of surgery for differentiated thyroid cancer: Recommended guideline. Oman Med J 2011;26:56-8.  Back to cited text no. 2
    
3.
Fernandes JK, Day TA, Richardson MS, Sharma AK. Overview of the management of differentiated thyroid cancer. Curr Treat Options Oncol 2005;6:47-57.  Back to cited text no. 3
    
4.
Malloy KM, Cunnane MF. Pathology and cytologic features of thyroid neoplasms. Surg Oncol Clin 2008;17:57-70.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    
6.
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.  Back to cited text no. 6
    
7.
Oltmann SC, Leverson G, Lin SH, Schneider DF, Chen H, Sippel RS. Markedly elevated thyroglobulin levels in the preoperative thyroidectomy patient correlates with metastatic burden. J Surg Res 2014;187:1-5.  Back to cited text no. 7
    
8.
Sands NB, Karls S, Amir A, Tamilia M, Gologan O, Rochon L, et al. McGill Thyroid Nodule Score (MTNS): “Rating the risk,” a novel predictive scheme for cancer risk determination. J Otolaryngol Head Neck Surg 2011;40 Suppl 1:S1-3.  Back to cited text no. 8
    
9.
Scheffler P, Forest VI, Leboeuf R, Florea AV, Tamilia M, Sands NB, et al. Serum thyroglobulin improves the sensitivity of the McGill thyroid nodule score for well-differentiated thyroid cancer. Thyroid 2014;24:852-7.  Back to cited text no. 9
    
10.
Rinaldi S, Plummer M, Biessy C, Tsilidis KK, Østergaard JN, Overvad K, et al. Thyroid stimulating hormone, thyroglobulin, and thyroid hormones and risk of differentiated thyroid carcinoma: The EPIC study. J Natl Cancer Inst 2014;106:4.  Back to cited text no. 10
    
11.
Kim H, Kim YN, Kim HI, Park SY, Choe JH, Kim JH, et al. Preoperative serum thyroglobulin predicts initial distant metastasis in patients with differentiated thyroid cancer. Sci Rep 2017;7:3.  Back to cited text no. 11
    
12.
Trimboli P, Treglia G, Giovanella L. Preoperative measurement of serum thyroglobulin to predict malignancy in thyroid nodules: A systematic review. Horm Metab Res 2015;47:247-52.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

 
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