Utilità del dosaggio della tireoglobulina e della calcitonina nel liquido di lavaggio degli agoaspirati per la diagnosi precoce delle metastasi linfonodali cervicali e delle recidive postoperatorie dei tumori della tiroide

Neck is an early location of lymphnode metastases and/or local recurrences from differentiated (DTC) and medullary (MTC) thyroid carcinonas. Diagnosis is mainly based on neck ultrasound and on cytological examination of ultrasound-guided fine needle aspiration biopsy (FNAB) from the suspect lesion, although this procedure accounts for 5-10% false negative results. Since thyroglobulin (Tg) is a sensitive and specific marker of DTC after total thyroidectomy, Tg assay in FNAB needle washout fluid (Tg-FNAB) has been proposed since early ‘90s to obtain diagnostic sensitivities and specificities near to 100%. Moreover, studies carried out by our group have shown that Tg-FNAB displays the same diagnostic values in patients with circulating anti-Tg antibodies (TgAb), who were previously excluded for the potential interference exerted by TgAb on Tg assay. Serum calcitonin (CT) is an exquisitely sensitive and specific marker of MTC even before thyroidectomy, but no data were until now available on the diagnostic usefulness of CT assay in the needle washout fluid of FNAB (CT-FNAB) in patients with MTC and suspect cervical masses. We have recently shown that, similarly to Tg-FNAB, CT-FNAB represents a highly sensitive and specific diagnostic procedure for the identification of lymphnode metastases and local recurrences in MTC. Taken together, assay of Tg and CT in FNAB fluid washout represents a simple and valuable diagnostic tool to be associated to ultrasound and cytology in the early diagnosis of lymph-node metastases and/or local recurrences in patients with thyroid tumors

Dosaggio della tireoglobulina (TG) negli agoaspirati linfonodali in pazienti con anticorpi anti-Tg (TgAb) circolanti.

INTRODUZIONE: Il dosaggio della Tg nell’agoaspirato (Tg-FNAB) è utilizzato per identificare le metastasi dei tumori differenziati della tiroide (DTC). Un nostro studio preliminare suggerisce che la presenza di TgAb circolanti non modifica significativamente la validità del dosaggio della Tg-FNAB a differenza della Tg sierica. SCOPO DELLO STUDIO: a) estendere la casistica precedentemente studiata, b) dosare i TgAb nel liquido di lavaggio dei linfonodi aspirati. SOGGETTI E METODI: 73 pazienti (41 operati per DTC, 32 con noduli tiroidei sospetti) valutati per la presenza di linfoadenopatie laterocervicali sospette, divisi in due gruppi in base alla positività (22 TgAb+) o negatività (51 TgAb-) dei TgAb. Prima del 2003 Tg e TgAb erano dosati con IRMA e agglutinazione passiva rispettivamente. Dopo il 2003 Tg e TgAb erano dosati in chemiluminescenza ultrasensibile (Immulite 2000 Thyroglobulin and Anti-TgAb). Valori di Tg-FNAB superiori ai cut-off stabiliti (>36 ng/ml e >1 ng/ml in presenza o assenza della tiroide) sono stati considerati indicativi di metastasi da DTC. RISULTATI: a) In tutti i 29 casi (14 TgAb+ e 15 TgAb-) con Tg-FNAB >cut-off l’istologia deponeva per metastasi di DTC indipendentemente dalla positività dei TgAb. Dei 44 casi (8 TgAb+ e 36 TgAb-) con Tg-FNAB <cut-off, 38 avevano citologia non sospetta e 6 (tutti TgAb-) citologia sospetta; in questi ultimi l’istologia documentava 4 metastasi di carcinoma tiroideo indifferenziato e 2 linfoadenopatie reattive. Escludendo i casi di metastasi indifferenziate, la sensibilità e la specificità della Tg-FNAB raggiungevano il 100% in entrambi gruppi, mentre per la citologia si raggiungevano valori lievemente inferiori. b) Recentemente in 19 pazienti (8 TgAb+ e 11 TgAb-), è stato associato al dosaggio della Tg-FNAB il dosaggio dei TgAb nell’aspirato linfonodale (TgAb-FNAB). TgAb-FNAB sono risultati indosabili in tutti i casi TgAb- e dosabili in 2/6 linfonodi metastatici TgAb+. Interessante il fatto che i livelli di Tg-FNAB nei casi TgAb-FNAB positivi erano inferiori ai rimanenti 4 casi, con TgAb-FNAB indosabili, pur mantenendosi sempre largamente superiori ai cut-off. CONCLUSIONI: Questo lavoro conferma ed estende i nostri risultati preliminari che indicano come i TgAb circolanti non alterino la validità diagnostica della Tg-FNAB. Poichè la presenza di TgAb-FNAB può raramente causare una sottostima dei valori di Tg-FNAB, suggeriamo di associare al dosaggio della Tg quello dei TgAb nei FNAB linfonodali di pazienti TgAb positivi. Dal momento che la Tg-FNAB può risultare indosabile nei casi di metastasi di carcinoma indifferenziato della tiroide è comunque sempre indispensabile associare l’esame citologico

The value of thyroglobulin (Tg) measurement in fine needel aspirates of neck lymph nodes in differentiated thyroid carcinoma is not affected by anti-Tg antibodies.

Serum thyroglobulin (Tg) is the most useful marker in the follow-up of patients after total thyroidectomy for differentiated thyroid carcinoma (DTC), but its usefulness is limited by the interference of serum anti-Tg antibodies (TgAb). Detection of Tg in the needle wash-out of fine-needle aspiration biopsy (Tg-FNAB) is also a very useful tool to identify metastatic neck lymph nodes in DTC, but, to our knowledge, no study has been carried out to evaluate a possible interference of serum TgAb in this procedure. We have therefore retrospectively reviewed 50 patients (25 after surgery for TC and 25 with suspicious thyroid nodules) referred to our institution for the presence of clinically suspicious cervical lymph nodes. All patients were submitted to ultrasound guided FNAB of neck lymph nodes to obtain cytological examination and detection of Tg in the needle wash-out. Patients were subdivided in two study groups: 18 patients showed detectable serum TgAb (TgAb+), while 32 had undetectable serum TgAb (TgAb-). Based on preliminary study, any Tg concentration >10 ng/ml in FNAB wash-out was considered abnormal. Tg-FNAB, cytological and histological results of surgically removed lymph nodes are showed in the table: GROUPS LYMPH NODES TgAb+ (n=18) Tg-FNAB >10 ng/ml (n=11) Tg-FNAB <10 ng/ml (n=7) Cyto+ (n=9) Cyto- (n=2) Cyto+ (n=0) Cyto- (n=7) Histo+ (n=9) Histo+ (n=2) TgAb-(n=32) Tg-FNAB >10 ng/ml (n=12) Tg-FNAB <10 ng/ml (n=20) Cyto+ (n=9) Cyto- (n=3) Cyto+ (n=5) Cyto- (n=15) Histo+ (n=9) Histo+ (n=3) Histo+ (n=3)* Histo- (n=2) Cyto+: cytology suspect for metastasis; Cyto-: cytology not suspect for metastasis Histo+: presence of metastasis at histology; Histo-:absence of metastasis at histology *All poorly differentiated tumors In conclusion, Tg assay in the needle wash-out of FNAB is not significantly affected by the presence of serum TgAb and this procedure remains superior to cytology in the identification of differentiated nodal metastases even in TgAb+ patients. However, cytology should always be performed, since Tg is undetectable in FNAB from undifferentiated metastases

The diagnostic value for differentiated thyroid carcinoma metastases of thyroglobulin (Tg) measurement in wash-out fluid from fine needle aspiration biopsy of neck lymph nodes is maintained in the presence of circulating anti-Tg antibodies

Objective: Serum thyroglobulin (Tg) is the marker of differentiated thyroid carcinoma (DTC) after total thyroidectomy, but its value is limited by the interference of anti-Tg antibodies (TgAb). Detection of Tg in fine-needle aspiration biopsy (Tg-FNAB) washout fluid is used to identify neck DTC recurrences/metastases, but the interference of serum TgAb in this procedure is unknown. Patients and Methods: Seventy-three patients (41 after surgery for thyroid cancer and 32 with thyroid nodules) evaluated for suspicious cervical lymph nodes were retrospectively reviewed. Tg was assayed by immunoradiometric assay or chemiluminescent assay in ultrasound-guided FNAB used for cytology. Serum TgAb were detected by passive agglutination or chemiluminescent assay. On the basis of preliminary data obtained in lymphadenitis, Tg-FNAB more than 36 ng/ml and more than 1.7 ng/ml (in the presence or absence of thyroid gland, respectively) was considered as indicative of metastasis. Results: In 51 TgAb-negative patients, Tg-FNAB was positive in 15 (12 with malignant and three with nondiagnostic cytology), all with histologically confirmed DTC metastases. Of the remaining 36 patients with negative Tg-FNAB, 30 had nonsuspicious and six had suspicious cytology. Histology of the latter showed four undifferentiated thyroid cancer metastases and two lymphadenitis. In 22 TgAb positive patients, Tg-FNAB was positive in 14 (12 with malignant and two with nondiagnostic cytology), all with histologically confirmed DTC metastases. Conclusions: Clinical performance of Tg-FNAB appears to be not substantially affected by TgAb, and this procedure remains superior to cytology in the identification of DTC neck metastases. However, cytology should always be performed because, irrespective of TgAb, Tg is undetectable in FNAB from undifferentiated metastases

The use of Fly Ash in Mine Tailings and Acid Mine Drainage Management

The paper is concerned with the results of a laboratory investigation conducted for the purpose of assessing the possibility of immobilizing heavy metals using fly ash from coal-fired power stations. Experiments have been carried out in reactors on solutions containing heavy metals, singly or in combination, admixing as received fly ash or a pre-screened size fraction. Moreover a parallel investigation has been carried out in plexiglass columns, containing respectively a sample of flotation tailings and a mixture of the same material and fly-ash. Results obtained so far show the potential of fly ash for immobilisation of heavy metal

SEA SALT UPGRADING

The paper is concerned with the results of an investigation carried out to explore the possibilities of using attrition cells as an alternative to the current vat system used in the S. Antioco salt works in SW Sardinia for the production of washed sea salt. Laboratory tests were conducted varying the operating parameters residence time in the attrition cells and in the centrifuge, solid/brine ratio; number of revolutions per minute of the mechanical stirrer. The results obtained justify the proposal for setting up a pilot plant for their verification and for determining the influencing parameters for industrial design and scale u

The value of thyroglobulin (tg) measurement in fine needle aspiration biopsy (FNAB) of neck lymph nodes in differentiated thyroid carcinoma is not affected by anti-tg antibodies.

OBJECTIVE: serum Tg is a specific marker in differentiated thyroid carcinoma (DTC) after total thyroidectomy, but its value in patients with serum anti-Tg antibodies (TgAb) is limited by the interference of TgAb in Tg assays. Detection of Tg in needle wash-out of FNAB (Tg-FNAB) is used to identify metastatic neck lymph nodes in DTC, but, to our knowledge, the interference of serum TgAb in this procedure is unknown. SUBJECTS AND METHODS: we have retrospectively reviewed 73 patients (41 after surgery for thyroid cancer and 32 with thyroid nodules) with suspicious cervical lymph nodes. Tg was assayed by IRMA or chemiluminescent assays in ultrasound-guided FNAB used for cytology. According to preliminary data obtained from reactive lymphoadenitis submitted to FNAB, any Tg-FNAB >1 ng/ml in thyroidectomized patients or >36 ng/ml in the presence of thyroid gland were considered as positive for metastasis. Serum TgAb were detected by chemiluminescent or RIA assays. RESULTS: in 51 TgAb-negative patients, Tg-FNAB exceeded the cut-off values in 15 (12 with malignant and 3 with not-diagnostic cytology), all with histologically confirmed DTC metastasis. Of the remaining 36 TgAb-negative patients with Tg-FNAB < cut-off, 30 had not-suspicious and 6 suspicious cytology. The latter were operated and 4 had poorly differentiated thyroid cancer metastases. In 22 TgAb-positive patients, Tg-FNAB exceeded the cut-off values in 14 (12 with malignant and 2 with not-diagnostic cytology), all with histologically confirmed DTC metastasis. In this group no suspicious cytology in the presence of negative Tg-FNAB was observed. CONCLUSIONS: Tg-FNAB is not affected by the presence of serum TgAb and this procedure remains superior to cytology in the identification of DTC nodal metastases. However, cytology should always be performed, since, independently form TgAb, Tg is undetectable in FNAB from poorly differentiated metastases

Use of natural Zeolites for Wastewater Treatment

The paper describes the results of an investigation conducted for the purpose of exploring the possibility of using a natural zeolite, occurring in central-northern Sardinia, for removing the ammonium ions contained in effluents discharged from wastewater treatment plants. Laboratory tests have been carried out on samples of wastewater effluents from a treatment facility in different sized columns containing appropriately ground zeolitic material, either untreated or in the Na-exchanged form. The results demonstrate the efficacy of the zeolite tested, especially in its Na-exchanged form, in removing the ammonium cation and the possibility of employing this mineral in municipal and industrial wastewater treatment processes