Endocrinology Service and Research Center, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Que., Canada.
Horm Res Paediatr. 2011;75(4):269-75. doi: 10.1159/000322877. Epub 2011 Jan 20.
BACKGROUND/AIMS: To assess whether the presence of certain findings on thyroid ultrasonography (US) correctly diagnoses malignancy even when a fine-needle aspiration biopsy (FNAB) suggests a benign lesion.
We reviewed the charts of 35 children and adolescents with a thyroid nodule who had had an US and a FNAB, and for whom final pathology was available.
The global accuracy of FNAB was 83%, with a sensitivity of 75% and a specificity of 94%. 14 FNABs suggested malignancy (40%), only 1 of which was a false positive (7%). By contrast, 5 of the 21 FNABs suggesting benign lesions were false negatives (24%). These 5 cases had US findings suggestive of malignancy. When FNAB suggested a benign lesion, US had a good sensitivity (80%) but a poor specificity and accuracy (50 and 57%, respectively); its negative predictive value was 90% and its positive predictive value 36%.
US complements FNAB in the evaluation of thyroid nodules in children. A more aggressive approach is warranted in children with a thyroid nodule and a benign FNAB if US findings suggest malignancy.
背景/目的：评估甲状腺超声（US）的某些发现是否能正确诊断恶性肿瘤，即使细针穿刺活检（FNAB）提示良性病变。
我们回顾了 35 名甲状腺结节患儿和青少年的图表，他们进行了 US 和 FNAB，并且有最终的病理结果。
FNAB 的总体准确率为 83%，灵敏度为 75%，特异性为 94%。14 例 FNAB 提示恶性（40%），其中只有 1 例为假阳性（7%）。相比之下，21 例 FNAB 提示良性病变中有 5 例为假阴性（24%）。这 5 例 US 检查有恶性肿瘤的表现。当 FNAB 提示良性病变时，US 的灵敏度较高（80%），但特异性和准确性较差（分别为 50%和 57%）；其阴性预测值为 90%，阳性预测值为 36%。
US 可补充 FNAB 用于儿童甲状腺结节的评估。如果 US 检查提示恶性肿瘤，对于 FNAB 提示良性的甲状腺结节患儿，应采取更积极的方法。
