Department of Surgery, Boston University, Boston, MA, USA.
Ann Surg Oncol. 2011 May;18(5):1300-5. doi: 10.1245/s10434-010-1452-y. Epub 2010 Dec 21.
Thyroid cancer is the most common endocrine malignancy. The current standard of diagnosis, fine-needle aspiration biopsy, yields approximately 10-25% of indeterminate results leading to twice as many thyroidectomies for further diagnosis. Elastic scattering spectroscopy (ESS) is a new, minimally invasive optical-biopsy technique mediated by fiber-optic probes that is sensitive to cellular and subcellular morphological features. We assessed the diagnostic potential of ESS in the thyroid to differentiate benign from malignant thyroid nodules as determined by histology.
Under an IRB approved protocol, 36 surgical patients (n = 21 benign thyroid nodules, n = 15 malignant tumors) had collection of ESS data from their fresh ex vivo thyroidectomy specimens. Using surgical pathology as our gold standard, spectral analyses were performed using a training set; these data were used to assess the ESS diagnostic potential using the leave-one-out technique.
Our test set was 75% sensitive and 95% specific in differentiating benign from malignant thyroid lesions, with a positive predictive value (PPV) of 0.92 and a negative predictive value (NPV) of 0.83.
The ESS can accurately distinguish benign vs malignant thyroid lesions with high PPV and NPV. With further validation ESS could potentially be used as an in situ real-time diagnostic tool or as an adjunct to conventional cytology.
甲状腺癌是最常见的内分泌恶性肿瘤。目前的诊断标准——细针抽吸活检，其结果约有 10-25%为不确定结果，导致为进一步诊断而进行的甲状腺切除术增加了一倍。弹性散射光谱（ESS）是一种新的、微创的光学活检技术，通过光纤探针介导，对细胞和亚细胞形态特征敏感。我们评估了 ESS 在甲状腺中的诊断潜力，以区分良性和恶性甲状腺结节，这些结节是通过组织学确定的。
根据 IRB 批准的方案，对 36 名手术患者（良性甲状腺结节 21 例，恶性肿瘤 15 例）的新鲜离体甲状腺切除术标本进行 ESS 数据采集。使用手术病理学作为我们的金标准，使用训练集进行光谱分析；使用留一法评估这些数据对 ESS 诊断的潜在价值。
我们的测试集在区分良性和恶性甲状腺病变方面的灵敏度为 75%，特异性为 95%，阳性预测值（PPV）为 0.92，阴性预测值（NPV）为 0.83。
ESS 可以准确地区分良性和恶性甲状腺病变，具有较高的 PPV 和 NPV。进一步验证后，ESS 可能有潜力成为一种实时原位诊断工具或作为常规细胞学的辅助手段。
