THE DIFFERENTIAL DIAGNOSIS OF CYSTIC NECK MASSES BY THE DETERMINATION OF THYROGLOBULIN CONCENTRATIONS IN THE ASPIRATES

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Abstract
Thyroglobulin (Tg) concentrations in the aspirates of various types of cystic neck masses were measured by RIA [radioimmunoassay] to assess the usefulness of this determination in differential diagnosis. The subjects consisted of 16 patients whose final diagnoses were all established on the basis of operative results; 3 patients had follicular thyroid adenomas (F-Ad), 11 had papillary thyroid carcinomas (P-Ca), 1 had a thyroglossal duct cyst (TDC) and 1 had a lateral cervical cyst (LCC). Tg concentrations in the cyst fluids of F-Ad and P-Ca were very high (0.042-2.83 mg/ml) compared with serum Tg concentrations. There was no difference in Tg concentrations in the fluids of P-Ca between primary lesions (n = 5) and metastatic lesions (n = 6). Tg concentrations of TDC and LCC were very low (< 100 ng/ml). Difficulty was experienced in diagnosing 3 patients, even though they had been examined by all nonsurgical diagnostic techniques. However, an occult thyroid carcinoma with lymph node metastasis was diagnosed by demonstrating a high Tg concentration in the aspirate of the cystic lymph node. T3[triiodothyronine] concentrations in cyst fluids of F-Ad were higher than those of P-Ca. T3 concentrations in the fluids of P-Ca, TDC and LCC did not differ, and were similar to serum T3 levels. Cytology of cyst fluids was positive in 4 of 10 patients examined with P-Ca. The thyroid origin of a cystic neck mass by demonstrating a high Tg concentration in the aspirate. This is especially useful for diagnosis in patients with thyroid carcinoma, including occult thyroid carcinomas with cystic lymph node metastasis.

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