粗针活检在甲状腺髓样癌患者中的作用及其对手术治疗的影响：三家医疗机构的临床经验
The Role of Core Needle Biopsy and Its Impact on Surgical Management in Patients with Medullary Thyroid Cancer: Clinical Experience at 3 Medical Institutions.
作者信息
Ha E J, Baek J H, Na D G, Kim J-h, Kim J K, Min H S, Song D E, Lee K E, Shong Y K
机构信息
From the Department of Radiology and the Research Institute of Radiology (E.J.H., J.H.B) Department of Radiology (E.J.H.), Ajou University School of Medicine, Suwon, Korea.
From the Department of Radiology and the Research Institute of Radiology (E.J.H., J.H.B)
出版信息
AJNR Am J Neuroradiol. 2015 Aug;36(8):1512-7. doi: 10.3174/ajnr.A4317. Epub 2015 Apr 30.
BACKGROUND AND PURPOSE
Medullary thyroid carcinoma is an uncommon malignancy that is challenging to diagnose. Our aim was to present our experience using core needle biopsy for the diagnosis of medullary thyroid carcinoma compared with fine-needle aspiration.
MATERIALS AND METHODS
Between January 2000 and March 2012, 202 thyroid nodules in 191 patients were diagnosed as medullary thyroid cancer by using sonography-guided fine-needle aspiration, core needle biopsy, or surgery. One hundred eighty-three thyroid nodules in 172 patients were included on the basis of the final diagnosis. We evaluated the sensitivity and positive predictive value of fine-needle aspiration and core needle biopsy for the diagnosis of medullary thyroid cancer. We compared the rate of a delayed diagnosis, a diagnostic surgery, and surgery with an incorrect diagnosis for fine-needle aspiration and core needle biopsy and investigated the factors related to the fine-needle aspiration misdiagnosis of medullary thyroid cancer.
RESULTS
Fine-needle aspiration showed 43.8% sensitivity and 85.1% positive predictive value for the diagnosis of medullary thyroid cancer; 25.7% (44/171) of patients had a delayed diagnosis, while 18.7% (32/171) underwent an operation for accurate diagnosis, and 20.5% (35/171) underwent an operation with an incorrect diagnosis. Core needle biopsy achieved 100% sensitivity and positive predictive value without a delay in diagnosis (0/22), the need for a diagnostic operation (0/22), or an operation for an incorrect diagnosis (0/22). A calcitonin level of <100 pg/mL was the only significant factor for predicting the fine-needle aspiration misdiagnosis of medullary thyroid cancer (P = .034).
CONCLUSIONS
Core needle biopsy showed a superior sensitivity and positive predictive value to fine-needle aspiration and could optimize the surgical management in patients with medullary thyroid cancer. Because the ability of fine-needle aspiration to diagnose medullary thyroid cancer significantly decreases in patients with serum calcitonin levels of <100 pg/mL, core needle biopsy could be indicated for these patients to optimize their surgical management.
背景与目的
甲状腺髓样癌是一种罕见的恶性肿瘤，诊断具有挑战性。我们的目的是介绍与细针穿刺抽吸相比，使用粗针活检诊断甲状腺髓样癌的经验。
材料与方法
2000年1月至2012年3月期间，191例患者中的202个甲状腺结节通过超声引导下细针穿刺抽吸、粗针活检或手术被诊断为甲状腺髓样癌。根据最终诊断纳入172例患者中的183个甲状腺结节。我们评估了细针穿刺抽吸和粗针活检诊断甲状腺髓样癌的敏感性和阳性预测值。我们比较了细针穿刺抽吸和粗针活检的延迟诊断率、诊断性手术率以及诊断错误的手术率，并调查了与甲状腺髓样癌细针穿刺抽吸误诊相关的因素。
结果
细针穿刺抽吸诊断甲状腺髓样癌的敏感性为43.8%，阳性预测值为85.1%；25.7%（44/171）的患者有延迟诊断，而18.7%（32/171）的患者接受了用于准确诊断的手术，20.5%（35/171）的患者接受了诊断错误的手术。粗针活检的敏感性和阳性预测值均达到100%，且无诊断延迟（0/22）、无需诊断性手术（0/22）或诊断错误的手术（0/22）。降钙素水平<100 pg/mL是预测甲状腺髓样癌细针穿刺抽吸误诊的唯一显著因素（P = 0.034）。
结论
粗针活检对细针穿刺抽吸显示出更高的敏感性和阳性预测值，并且可以优化甲状腺髓样癌患者的手术管理。由于血清降钙素水平<100 pg/mL的患者中细针穿刺抽吸诊断甲状腺髓样癌的能力显著降低，对于这些患者可考虑进行粗针活检以优化其手术管理。
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