Zimny M, Selkinski I, Blasius S, Rink T, Schroth H-J, Grünwald F
Department of Nuclear Medicine, Klinikum Hanau, Leimenstraße, Hanau, Germany.
Nuklearmedizin. 2012;51(4):119-24. doi: 10.3413/Nukmed-0456-12-01. Epub 2012 Apr 12.
The cytological diagnosis of follicular neoplasm is a common finding in fine needle aspiration cytology (FNAC) of thyroid nodules and includes benign disease as well as differentiated thyroid cancer. The aim of the study is to determine if thyrotropin is a predictive factor for a malignant nature of follicular neoplasm.
PATIENTS, METHODS: The records of 119 patients with follicular neoplasm on FNAC, who underwent surgery for final diagnosis, were reviewed retrospectively. The predictive value of serum parameters including thyrotropin, thyroglobulin, and anti-thyroid antibodies, ultrasonographic criteria and clinical variables was evaluated by univariate analysis and logistic regression analysis.
RESULTS, DISCUSSION: Patients with malignant nodules showed a higher thyrotropin concentration compared to patients with benign nodules (median 1.6 mU/l, interquartile range 1.4-3.0 mU/l vs. median 1.2 mU/l, interquartile range 0.8-1.6 mU/l, p < 0.01). ROC-analysis of thyrotropin revealed an optimal cut off value to differentiate benign and malignant nodules of 1.34 mU/l. The incidence of malignancy was 30.3% for a thyrotropin concentration higher than 1.34 mU/l compared to 6.4% for a thyrotropin concentration lower than or equal to 1.34 mU/l. On univariate analysis thyroglobulin higher than 300 ng/ml, positive anti-thyroid antibodies, hypoechogenicity, and ill-defined margins, respectively, were also significantly associated with malignancy. On logistic regression analysis higher thyrotropin concentrations, ill-defined margins, and thyroglobulin higher than 300 ng/ml, respectively, were independent predictive factors for malignancy (OR 20.0, 10.7, and 22.7, respectively).
Higher thyrotropin concentrations are predictive for a malignant nature of follicular neoplasm.
滤泡性肿瘤的细胞学诊断是甲状腺结节细针穿刺活检（FNAC）中常见的结果，包括良性疾病以及分化型甲状腺癌。本研究的目的是确定促甲状腺激素是否为滤泡性肿瘤恶性性质的预测因素。
患者、方法：回顾性分析119例经FNAC诊断为滤泡性肿瘤并接受手术以明确最终诊断的患者记录。通过单因素分析和逻辑回归分析评估包括促甲状腺激素、甲状腺球蛋白和抗甲状腺抗体在内的血清参数、超声标准和临床变量的预测价值。
结果、讨论：与良性结节患者相比，恶性结节患者的促甲状腺激素浓度更高（中位数1.6 mU/l，四分位间距1.4 - 3.0 mU/l，而良性结节患者中位数为1.2 mU/l，四分位间距0.8 - 1.6 mU/l，p < 0.01）。促甲状腺激素的ROC分析显示，区分良性和恶性结节的最佳临界值为1.34 mU/l。促甲状腺激素浓度高于1.34 mU/l时，恶性发生率为30.3%，而促甲状腺激素浓度低于或等于1.34 mU/l时为6.4%。单因素分析显示，甲状腺球蛋白高于300 ng/ml、抗甲状腺抗体阳性、低回声以及边界不清分别也与恶性显著相关。逻辑回归分析显示，促甲状腺激素浓度升高、边界不清以及甲状腺球蛋白高于300 ng/ml分别是恶性的独立预测因素（OR分别为20.0、10.7和22.7）。
促甲状腺激素浓度升高可预测滤泡性肿瘤的恶性性质。
