Petric Rok, Besic Hana, Besic Nikola
Department of Surgical Oncology, Institute of Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia.
World J Surg Oncol. 2014 Sep 12;12:282. doi: 10.1186/1477-7819-12-282.
Cytologic examination of a fine-needle aspiration biopsy specimen cannot distinguish between benign and malignant follicular or Hürthle cell neoplasms. Serum thyroglobulin (Tg) concentrations are higher in follicular and Hürthle cell carcinomas than in benign follicular or Hürthle cell tumors, but preoperative measurement of Tg is not recommended for initial evaluation of thyroid nodules. The aim of this study was to find out whether preoperative serum Tg concentration is a predictive factor of malignant disease in patients with a follicular or Hürthle cell neoplasm with a diameter of 2 cm or less.
From 1988 to 2013, a total of 244 patients (214 female, 30 male, age range 9 to 82 years, median age 52 years) had a surgical procedure at our institute because of follicular or Hürthle cell neoplasms with a tumor diameter of 2 cm or less. In these patients a preoperative concentration of Tg was determined and Tg-autoantibodies were negative. The risk factors for malignancy were identified by a chi-square test and multivariate logistic regression.
The histopathologic diagnoses were carcinoma, adenoma, and benign goiter in 62 (25.5%), 115 (47%), and 67 (27.5%) patients, respectively. The median preoperative Tg concentration in benign tumors, papillary carcinomas, follicular carcinomas, and Hürthle cell carcinomas was 41, 87, 72, and 106 ng/ml (P = 0.05), respectively. The predictive factors for carcinoma shown by the chi-square test were: sex, thyroid volume, and preoperative Tg concentration. The independent predictors of malignancy as shown by multivariate logistic regression were: male sex (odds ratio, 2.57; P = 0.02), and a Tg concentration of more than 80 ng/ml (odds ratio, 2.35; P = 0.005).
The independent predictors of malignancy in follicular or Hürthle cell neoplasms are sex and preoperative Tg concentration.
细针穿刺活检标本的细胞学检查无法区分良性和恶性滤泡性或许特莱细胞肿瘤。滤泡性和许特莱细胞癌患者的血清甲状腺球蛋白（Tg）浓度高于良性滤泡性或许特莱细胞肿瘤患者，但不建议在术前检测Tg以用于甲状腺结节的初步评估。本研究的目的是确定术前血清Tg浓度是否为直径2cm及以下的滤泡性或许特莱细胞肿瘤患者恶性疾病的预测因素。
1988年至2013年，共有244例患者（214例女性，30例男性，年龄9至82岁，中位年龄52岁）因直径2cm及以下的滤泡性或许特莱细胞肿瘤在我院接受手术。测定这些患者术前的Tg浓度，且Tg自身抗体为阴性。通过卡方检验和多因素逻辑回归分析确定恶性肿瘤的危险因素。
组织病理学诊断分别为癌、腺瘤和良性甲状腺肿的患者有62例（25.5%）、115例（47%）和67例（27.5%）。良性肿瘤、乳头状癌、滤泡性癌和许特莱细胞癌术前Tg浓度的中位数分别为41、87、72和106 ng/ml（P = 0.05）。卡方检验显示的癌的预测因素为：性别、甲状腺体积和术前Tg浓度。多因素逻辑回归分析显示的恶性肿瘤独立预测因素为：男性（比值比，2.57；P = 0.02），以及Tg浓度超过80 ng/ml（比值比，2.35；P = 0.005）。
滤泡性或许特莱细胞肿瘤恶性肿瘤的独立预测因素是性别和术前Tg浓度。
