Lumachi Franco, Varotto Lucia, Borsato Simonetta, Tregnaghi Alberto, Zucchetta Pietro, Marzola Maria Cristina, Cecchin Diego, Bui Franco
Endocrine Surgery Unit, Department of Surgical and Gastoenterological Sciences, University of Padua, School of Medicine, 35128 Padova, Italy.
Anticancer Res. 2004 Jul-Aug;24(4):2531-4.
The aim of this study was to evaluate the accuracy of fine-needle aspiration (FNA) cytology and thyroid scintigraphy (TS) in patients with solitary thyroid nodules. We retrospectively reviewed a series of 657 consecutive patients (531 (80.8%) women and 126 (19.2%) men, median age 45 years, range 16-81 years) with solitary thyroid nodules. Prior to surgery, all patients underwent FNA cytology whilst 99mTc-pertechnetate TS was performed in 496 (75.5%) patients. Final histopathology showed 533 (81.1%) benign nodules, including 251 (38.2%) follicular adenomas and 124 (18.9%) thyroid carcinomas. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy in the detection of thyroid cancer were 95.8%, 21.1%, 22.6%, 95.5% and 35.7% for TS, and 81.4%, 99.4%, 97.1%, 95.8% and 96.0% for FNA cytology. The presence of thyroid cancer was confirmed in 92 out of 407 (22.6%) patients with a "cold" nodule, in 4 (4.5%) patients who had normal or increased uptake on TS, in 101 out of 104 (97.1%) patients with smears suggesting malignancy, and in 3 out of 533 (0.6%) smears suggesting benign lesions. In conclusion, the specificity of TS is low and this technique should be abandoned as a routine test in patients with nontoxic thyroid nodules. However, a more careful evaluation should be suggested for patients with cold thyroid nodules and a FNA cytology that reads follicular neoplasm.
本研究旨在评估细针穿刺（FNA）细胞学检查和甲状腺闪烁扫描（TS）对孤立性甲状腺结节患者的诊断准确性。我们回顾性分析了657例连续的孤立性甲状腺结节患者（531例（80.8%）为女性，126例（19.2%）为男性，中位年龄45岁，年龄范围16 - 81岁）。手术前，所有患者均接受FNA细胞学检查，496例（75.5%）患者进行了99mTc - 高锝酸盐TS检查。最终组织病理学检查显示533例（81.1%）为良性结节，包括251例（38.2%）滤泡性腺瘤和124例（18.9%）甲状腺癌。TS检测甲状腺癌的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为95.8%、21.1%、22.6%、95.5%和35.7%，FNA细胞学检查分别为81.4%、99.4%、97.1%、95.8%和96.0%。407例（22.6%）“冷”结节患者中有92例确诊为甲状腺癌，TS检查摄取正常或增加的患者中有4例（4.5%）确诊，涂片提示恶性的104例患者中有101例（97.1%）确诊，涂片提示良性病变的533例患者中有3例（0.6%）确诊。总之，TS的特异性较低，该技术不应作为非毒性甲状腺结节患者的常规检查。然而，对于冷甲状腺结节和FNA细胞学检查提示滤泡性肿瘤的患者，应建议进行更仔细的评估。
