de Crea C, Raffaelli M, Maccora D, Carrozza C, Canu G, Fadda G, Bellantone R, Lombardi C P
UO Chirurgia Endocrina e Metabolica.
UO Analisi Ormonali and.
Acta Otorhinolaryngol Ital. 2014 Dec;34(6):399-405.
Ultrasound-guided fine-needle aspiration biopsy cytology (FNAB-C) is able to detect approximately 63% of medullary thyroid carcinoma (MTC). The measurement of calcitonin in the needle washout (FNAB-CT) could improve its accuracy. Sixty-two FNAB-C were performed in 38 patients. Serum calcitonin (sCT) was measured before performing FNAB-C. After obtaining a FNAB-C specimen, the needle was washed with 0.5 ml of saline solution to obtain the CT washouts. Receiver operating characteristic (RO C) analysis identified the cut-offs of FNAB-CT and FNAB-CT/sCT. Eighteen MTC were found at final histology. RO C analysis indicated FNAB-CT > 10.4 pg/ml and FNABCT/ sCT > 1.39 as more accurate cut-off values. Overall accuracy, positive (PPV) and negative predictive values (NPV) were 85%, 100 and 83%, respectively, for FNAB-C, 97%, 100%, 96% for FNAB-CT and 90%, 83% and 93% for FNAB-CT/sCT. The integration of FNAB-C and FNAB-CT resulted in 98% overall accuracy, 100% PPV and 98% NPV; the integration of FNAB-C and FNAB-CT/sCT in 90% overall accuracy, 80% PPV and 95% NPV. One of 2 false negative FNAB-CT and one of 3 false negative FNAB CT/sCT were correctly diagnosed by FNAB-C. Eight of 9 non-diagnostic FNAB-C were correctly classified by FNAB-CT and 7 by FNAB CT/sCT. FNAB-CT should integrate but not replace FNAB-C. FNAB-CT is particularly useful in the presence of non-diagnostic FNAB-C.
超声引导下细针穿刺活检细胞学检查（FNAB-C）能够检测出约63%的甲状腺髓样癌（MTC）。对穿刺冲洗液中的降钙素进行检测（FNAB-CT）可提高其准确性。对38例患者进行了62次FNAB-C检查。在进行FNAB-C检查前检测血清降钙素（sCT）。获取FNAB-C标本后，用0.5 ml盐溶液冲洗穿刺针以获取CT冲洗液。通过受试者操作特征（ROC）分析确定FNAB-CT和FNAB-CT/sCT的临界值。最终组织学检查发现18例MTC。ROC分析表明，FNAB-CT>10.4 pg/ml和FNABCT/sCT>1.39为更准确的临界值。FNAB-C的总体准确率、阳性预测值（PPV）和阴性预测值（NPV）分别为85%、100%和83%；FNAB-CT的分别为97%、100%、96%；FNAB-CT/sCT的分别为90%、83%和93%。FNAB-C与FNAB-CT联合使用时总体准确率为98%，PPV为100%，NPV为98%；FNAB-C与FNAB-CT/sCT联合使用时总体准确率为90%，PPV为80%，NPV为95%。2例假阴性FNAB-CT中的1例以及3例假阴性FNAB CT/sCT中的。9例无法诊断的FNAB-C中有8例通过FNAB-CT正确分类，7例通过FNAB CT/sCT正确分类。FNAB-CT应与FNAB-C联合使用而不是替代FNAB-C。在FNAB-C无法诊断时，FNAB-CT特别有用。
