Frasoldati Andrea, Valcavi Roberto
Endocrine Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
Endocr Pract. 2004 May-Jun;10(3):261-8. doi: 10.4158/EP.10.3.261.
To assess the performance of neck ultrasonography (US) in the detection of lymph node lesions metastatic from differentiated thyroid carcinoma (DTC) and the detection of parathyroid adenomas.
Neck US was performed in 667 patients with DTC (173 men and 494 women; mean age, 47.7 years). In cases of suspicious neck nodes, US-guided fine-needle aspiration biopsy (US-FNAB) plus measurement of thyroglobulin in the needle washouts (FNAB-Tg) was done. In addition, 75 patients with primary hyperparathyroidism (pHPT) (15 men and 60 women; mean age, 56 years) underwent neck US and sestamibi scintiscanning for localization of parathyroid adenoma. For confirmation of US findings, US-FNAB plus measurement of parathyroid hormone in the needle washouts (FNAB-PTH) was performed. FNAB-PTH was also measured in 129 suspected parathyroid adenomas incidentally detected in a series of 4,129 patients undergoing neck US examination for thyroid disease.
The presence of DTC metastatic lesions was confirmed in 46 of 95 patients with suspicious neck nodes. US sensitivity and specificity were 82.1% and 91.2%, respectively. The positive predictive value (PPV) of US-FNAB + FNAB-Tg was 94.7%. In the 75 patients with pHPT, US followed by US-FNAB + FNAB-PTH showed a higher PPV (97.5%) in comparison with sestamibi scintiscanning (83.7%) in the detection of parathyroid adenoma. A parathyroid adenoma was also incidentally detected in 0.62% of the 4,129 patients undergoing neck US for thyroid disease.
US accurately detects DTC neck metastatic lesions and localizes parathyroid adenomas. Moreover, neck US may lead to discovery of parathyroid incidentalomas.
评估颈部超声（US）在检测分化型甲状腺癌（DTC）转移的淋巴结病变以及甲状旁腺腺瘤方面的性能。
对667例DTC患者（173例男性和494例女性；平均年龄47.7岁）进行颈部超声检查。对于颈部可疑淋巴结的病例，进行超声引导下细针穿刺活检（US-FNAB）并测定针吸冲洗液中的甲状腺球蛋白（FNAB-Tg）。此外，75例原发性甲状旁腺功能亢进症（pHPT）患者（15例男性和60例女性；平均年龄56岁）接受颈部超声和锝-99m甲氧基异丁基异腈闪烁扫描以定位甲状旁腺腺瘤。为了证实超声检查结果，进行US-FNAB并测定针吸冲洗液中的甲状旁腺激素（FNAB-PTH）。在4129例因甲状腺疾病接受颈部超声检查的患者中偶然发现的129例疑似甲状旁腺腺瘤中也进行了FNAB-PTH测定。
95例颈部可疑淋巴结患者中，46例确诊为DTC转移病变。超声的敏感性和特异性分别为82.1%和91.2%。US-FNAB + FNAB-Tg的阳性预测值（PPV）为94.7%。在75例pHPT患者中，与锝-99m甲氧基异丁基异腈闪烁扫描（83.7%）相比，超声检查后进行US-FNAB + FNAB-PTH在检测甲状旁腺腺瘤方面显示出更高的PPV（97.5%）。在4129例因甲状腺疾病接受颈部超声检查的患者中，0.62%的患者偶然发现了甲状旁腺腺瘤。
超声能准确检测DTC颈部转移病变并定位甲状旁腺腺瘤。此外，颈部超声可能导致意外发现甲状旁腺腺瘤。
