评估甲状腺结节大小与恶性肿瘤及细针穿刺活检（FNAB）准确性之间的关系。
Evaluation the Relationship Between Thyroid Nodule Size with Malignancy and Accuracy of Fine Needle Aspiration Biopsy (FNAB).
作者信息
Godazandeh Gholamali, Kashi Zahra, Zargarnataj Sadegh, Fazli Mehran, Ebadi Robab, Kerdabadi Ensiyeh Hajializadeh
机构信息
Department of Thoracic Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Department of Endocrinology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
出版信息
Acta Inform Med. 2016 Oct;24(5):347-350. doi: 10.5455/aim.2016.24.347-350. Epub 2016 Nov 1.
INTRODUCTION
Some studies have shown largest thyroid nodule size, especially ≥4cm that can predict malignancy and reduce fine needle aspiration biopsy (FNAB) accuracy. Therefore, this study is designed to evaluate relationship between thyroid nodule sizes with malignancy and its effect on FNBA accuracy.
MATERIALS AND METHODS
a retrospective analytical study design aims to investigate all patients with thyroid nodules who referred to surgery department of Imam-Khomeini Hospital of Mazandaran University of Medical Sciences in Sari from 20 March 2008 to 22 March 2014. We collected patient's demographic data, nodules size, FNAB reports and final pathology (after surgery) reports from their medical records. All data were analyses performed by SPSS18.
RESULTS
167 patients (153 women) with mean age of 41.56±13.24 years old were enrolled for this study. In final pathology; 38 patients (22.8%) had malignant nodules. The mean age of patients with or without malignant nodules were 34.93±11.86 and 42.37±12.26 years old, respectively (P=0.002). The mean size of benign and malignant nodules were 2.91±1.29 cm and 3.38±1.86 cm, respectively (P=0.15). 25.2% of <4 cm nodules and 17.9% of ≥4 cm nodules were diagnosed as a malignant (P=0.29). FNAB was done on 95 patients that reported benign in 60 patients (63.2%), malignant in 18 patients (18.9%) and suspicious in 17 patients (17.9%). Positive and negative results of FNAB in all nodules were 3.5% and 6.3%, in <4cm nodules were 5.8% and 6.2% and in ≥4cm nodules were zero and 6.7%, respectively. The sensitivity, specificity, Positive predict value (PPV), negative predict value (NPV) and overall accuracy (OA) of FNAB in all nodules were 76.19%, 96.49%, 88.88%, 91.66% and 91.02%, and in <4cm nodules were 78.57%, 94.11%, 84.61%, 91.42% and 89.58%, and in ≥4cm nodules were 71.4%, 100%, 100%, 92% and 93.33%, respectively.
CONCLUSION
the results of this study revealed that the size of the thyroid nodules is not reliable at predicting malignancy and should not be applied in medical decision making. FNAB showed good specificity but the sensitivity was low in our study. In ≥4cm nodules; FNAB sensitivity was decreased and accompanied by higher false-negative results. Furthermore, FNABs with suspicious results were associated with high probability of malignancy.
引言
一些研究表明，甲状腺结节的最大尺寸，尤其是≥4厘米，可预测恶性肿瘤并降低细针穿刺活检（FNAB）的准确性。因此，本研究旨在评估甲状腺结节大小与恶性肿瘤之间的关系及其对FNBA准确性的影响。
材料与方法
一项回顾性分析研究旨在调查2008年3月20日至2014年3月22日转诊至萨里马赞德兰医科大学伊玛目霍梅尼医院外科的所有甲状腺结节患者。我们从他们的病历中收集了患者的人口统计学数据、结节大小、FNAB报告和最终病理（手术后）报告。所有数据均使用SPSS18进行分析。
结果
本研究纳入了167例患者（153例女性），平均年龄为41.56±13.24岁。在最终病理检查中，38例患者（22.8%）有恶性结节。有或无恶性结节患者的平均年龄分别为34.93±11.86岁和42.37±12.26岁（P=0.002）。良性和恶性结节的平均大小分别为2.91±1.29厘米和3.38±1.86厘米（P=0.15）。<4厘米结节中有25.2%被诊断为恶性，≥4厘米结节中有17.9%被诊断为恶性（P=0.29）。对95例患者进行了FNAB，其中60例报告为良性（63.2%），18例报告为恶性（18.9%），17例报告为可疑（17.9%）。所有结节中FNAB的阳性和阴性结果分别为3.5%和6.3%，<4厘米结节中分别为5.8%和6.2%，≥4厘米结节中分别为零和6.7%。所有结节中FNAB的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和总体准确性（OA）分别为76.19%、96.49%、88.88%、91.66%和91.02%，<4厘米结节中分别为78.57%、94.11%、84.61%、91.42%和89.58%，≥4厘米结节中分别为71.4%、100%、100%、92%和93.33%。
结论
本研究结果表明，甲状腺结节大小在预测恶性肿瘤方面不可靠，不应应用于医疗决策。FNAB显示出良好的特异性，但在我们的研究中敏感性较低。在≥4厘米的结节中，FNAB敏感性降低，伴有较高的假阴性结果。此外，结果可疑的FNAB与恶性肿瘤的高概率相关。
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