Puylaert J B, Pauwels E K, Goslings B M, Van Daal W A
Clin Nucl Med. 1985 Sep;10(9):646-9. doi: 10.1097/00003072-198509000-00011.
Thyroid scintigraphy with Tc-99m pertechnetate was performed in 249 patients who received radiation therapy for abnormalities in the head or neck in order to determine the role of this examination in the detection of abnormal nodules arising from cancer. These patients received a mean total dose of about 10.1 Gy. The mean follow-up period was 39 years. All patients underwent physical examination without prior knowledge of the scintigram. Scintigrams were evaluated without prior knowledge of the physical examination. In 158 cases, both the physical examination and scintigraphy were negative. In 64 cases, both examinations were positive. In ten patients, the physical examination was positive and scintigraphy was negative and vice versa in 17 patients. Of 249 patients, 28 ultimately underwent thyroid surgery; a total of four had carcinoma. A cost-benefit relationship as to routine scintigraphy as a screening procedure is presented. If patients are first screened by palpation, a number of abnormal nodules will be missed. In addition, a considerable number with positive palpation would probably undergo surgery unnecessarily. From a clinical and financial point of view, it is believed that scintigraphy is the examination of choice for screening for radiation-induced thyroid malignancies.
对249例因头颈部异常接受放射治疗的患者进行了锝-99m高锝酸盐甲状腺闪烁扫描，以确定该检查在检测癌症引起的异常结节中的作用。这些患者接受的平均总剂量约为10.1 Gy。平均随访期为39年。所有患者在不知晓闪烁扫描结果的情况下接受体格检查。在不知晓体格检查结果的情况下评估闪烁扫描图像。158例患者的体格检查和闪烁扫描均为阴性。64例患者两项检查均为阳性。10例患者体格检查阳性而闪烁扫描阴性，17例患者则相反。249例患者中，28例最终接受了甲状腺手术；其中共有4例患有癌症。本文给出了将常规闪烁扫描作为筛查程序的成本效益关系。如果首先通过触诊对患者进行筛查，将会漏诊一些异常结节。此外，相当一部分触诊阳性的患者可能会不必要地接受手术。从临床和经济角度来看，人们认为闪烁扫描是筛查放射性甲状腺恶性肿瘤的首选检查方法。
