Hales Nathan W, Krempl Greg A, Medina Jesus E
Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Am J Otolaryngol. 2008 Mar-Apr;29(2):113-8. doi: 10.1016/j.amjoto.2007.04.006.
The aim of this study was to determine the accuracy of the fluorine 18 ((18)F)-labeled fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan in the evaluation of thyroid nodules in which the cytopathology of fine-needle aspiration (FNA) biopsies are classified as "indeterminate," ie, either follicular or Hürthle cell lesion.
At an academic medical center, we conducted a prospective pilot study of 15 patients with thyroid nodules in whom adequate FNA was diagnosed as indeterminate. All patients underwent a whole-body FDG-PET/CT scan followed by thyroidectomy. Preoperative FDG-PET/CT results and the histopathology of the surgical specimen were compared and statistically analyzed.
The FNA demonstrated follicular cells in 11 (73%) patients, Hürthle cells in 3 (20%) patients, and both types of cells in 1 (7%) patient. The histopathology of the surgical specimen revealed thyroid cancer in 7 (47%) patients. The FDG-PET/CT scan was positive in 8 patients; 4 (50%) patients were found to have cancer. The FDG-PET/CT scan was negative in 7 patients. Four of these patients had benign lesions and 3 had thyroid carcinoma. Thus, 4 (27%) patients had false-positive FDG-PET/CT scans and 3 (20%) patients had false-negative studies. The sensitivity of FDG-PET/CT to detect a malignant focus was 57% with a specificity of 50%. The positive predictive value was 50% and the negative predictive value was 57%.
In this pilot study of patients with cytologically indeterminate thyroid nodules, FDG-PET/CT was not a predictable indicator of benign or malignant disease. Although a larger series may elucidate a role for FDG-PET/CT, the relatively low predictability shown in this study should caution clinicians about using FDG-PET/CT to consider foregoing thyroidectomy for cytologically indeterminate nodules.
本研究旨在确定氟18（¹⁸F）标记的氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在评估细针穿刺（FNA）活检细胞病理学分类为“不确定”（即滤泡性或许特耳细胞病变）的甲状腺结节中的准确性。
在一家学术医疗中心，我们对15例甲状腺结节患者进行了一项前瞻性试点研究，这些患者的FNA诊断为不确定。所有患者均接受全身FDG-PET/CT扫描，随后进行甲状腺切除术。比较术前FDG-PET/CT结果与手术标本的组织病理学，并进行统计分析。
FNA显示11例（73%）患者为滤泡细胞，3例（20%）患者为许特耳细胞，1例（7%）患者为两种细胞类型。手术标本的组织病理学显示7例（47%）患者为甲状腺癌。FDG-PET/CT扫描8例患者为阳性；其中4例（50%）患者被发现患有癌症。7例患者FDG-PET/CT扫描为阴性。这些患者中4例有良性病变，3例有甲状腺癌。因此，4例（27%）患者FDG-PET/CT扫描出现假阳性，3例（20%）患者出现假阴性。FDG-PET/CT检测恶性病灶的敏感性为57%，特异性为50%。阳性预测值为50%，阴性预测值为57%。
在这项针对细胞学检查不确定的甲状腺结节患者的试点研究中，FDG-PET/CT并非良性或恶性疾病的可预测指标。尽管更大规模的系列研究可能会阐明FDG-PET/CT的作用，但本研究中显示的相对较低的可预测性应提醒临床医生在考虑对细胞学检查不确定的结节不进行甲状腺切除术时谨慎使用FDG-PET/CT。
