Department of Surgery, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
World J Surg. 2010 Jun;34(6):1247-53. doi: 10.1007/s00268-010-0398-3.
In all, 20% of fine-needle aspiration (FNA) biopsies of thyroid nodules have an indeterminate diagnosis; of these, 80% are found to be benign after thyroidectomy. Some previous reports indicate that positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) imaging may predict malignancy status. We now report results on the first 51 patients in the largest prospective study of FDG-PET in patients with an indeterminate thyroid nodule FNA.
Eligible patients had a dominant thyroid nodule that was palpable or >or=1 cm in greatest dimension as seen by ultrasonography, and indeterminate histology of the FNA biopsy specimen. Participants underwent preoperative neck FDG-PET alone or FDG-PET with computed tomography (FDG-PET/CT). Images were evaluated qualitatively and semiquantitatively using the maximum standardized uptake value (SUV(max)). Final diagnosis was determined by histopathologic analysis after thyroidectomy. Descriptive statistical analysis was performed.
A total of 51 patients underwent preoperative FDG-PET or FDG-PET/CT. Studies without focally increased uptake localized to the lesion were considered negative. For all lesions (10 malignant, 41 benign), the sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) were 80%, 61%, 33%, and 93%, respectively. Postoperatively, two malignant and six benign lesions were found to be <1 cm by pathology examination; one lesion was not measured. When these lesions were excluded, the sensitivity, specificity, PPV, and NPV were 100%, 59%, 36%, and 100%, respectively.
Based on these preliminary data, FDG-PET may have a role in excluding malignancy in thyroid nodules with an indeterminate FNA biopsy. This finding justifies ongoing accrual to our target population of 125 participants.
总的来说，甲状腺结节细针穿刺活检（FNA）中有 20%的诊断结果不明确；其中，80%在甲状腺切除术后被发现为良性。一些先前的报告表明，正电子发射断层扫描（PET）结合（18）F-氟代脱氧葡萄糖（FDG）成像可能预测恶性肿瘤状态。我们现在报告了首例 51 例患者的研究结果，这些患者在最大的 FDG-PET 前瞻性研究中患有甲状腺结节 FNA 不明确。
合格的患者具有可触及或超声检查最大直径>或=1cm 的显性甲状腺结节，且 FNA 活检标本的组织学不明确。参与者接受术前颈部 FDG-PET 或 FDG-PET/CT。使用最大标准化摄取值（SUV(max)）进行定性和半定量图像评估。最终诊断通过甲状腺切除术后的组织病理学分析确定。进行描述性统计分析。
共有 51 例患者接受了术前 FDG-PET 或 FDG-PET/CT。无局灶性摄取的研究被认为是阴性的。对于所有病变（10 个恶性，41 个良性），敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 80%、61%、33%和 93%。术后，2 个恶性和 6 个良性病变在病理检查中发现<1cm；一个病变未被测量。当排除这些病变时，敏感性、特异性、PPV 和 NPV 分别为 100%、59%、36%和 100%。
基于这些初步数据，FDG-PET 可能在排除甲状腺结节 FNA 活检不明确的恶性肿瘤方面具有作用。这一发现证明了我们对 125 名目标人群的持续入组是合理的。
