Loy T J, Sundram F X
Department of Nuclear Medicine, Singapore General Hospital.
Ann Acad Med Singap. 1989 Nov;18(6):658-64.
The study attempts to assess the accuracy of radionuclide scan, ultrasonography and fine-needle aspiration biopsy as diagnostic tools in distinguishing malignant from benign nodular thyroid lesions in Singapore. The medical case records of 537 patients referred to the Department of Nuclear Medicine were analysed. 94% of the solitary thyroid nodules delineated on scintiscan were "cold". The incidence of malignancy in solitary "cold" thyroid nodules was 8%, and that in multinodular goitres was 2.3%. The sensitivity of both radionuclide scan and ultrasonography in detecting cancer was 100%, but the specificity was disappointingly low, i.e. 3.6% for radionuclide scan and 21% for ultrasonography. The sensitivity for fine-needle aspiration biopsy was 85%, and the specificity 96%. Fine-needle aspiration cytology is indisputable as an accurate diagnostic tool in differentiating malignant from benign thyroid lesions, and should be the first test to be used in the diagnostic workup of nodular thyroid disease. However, both radionuclide scan and ultrasonography remain crucial in the subsequent management of patients with thyroidectomy done for thyroid cancer. The other major roles are in the management of thyroiditis, thyrotoxicosis and confirmation of ectopic thyroid tissue.
该研究旨在评估放射性核素扫描、超声检查和细针穿刺活检作为诊断工具，在新加坡区分甲状腺结节性病变良恶性方面的准确性。分析了转诊至核医学科的537例患者的病历。闪烁扫描显示的孤立性甲状腺结节中，94%为“冷结节”。孤立性“冷结节”的恶性发生率为8%，多结节性甲状腺肿的恶性发生率为2.3%。放射性核素扫描和超声检查检测癌症的敏感性均为100%，但特异性令人失望地低，放射性核素扫描为3.6%，超声检查为21%。细针穿刺活检的敏感性为85%，特异性为96%。细针穿刺细胞学检查无疑是区分甲状腺病变良恶性的准确诊断工具，应作为甲状腺结节性疾病诊断检查的首选。然而，放射性核素扫描和超声检查在随后接受甲状腺癌甲状腺切除术患者的管理中仍至关重要。其他主要作用在于甲状腺炎、甲状腺毒症的管理以及异位甲状腺组织的确认。
