Rakib S A, Sharif S B, Nahar A, Alam S M
Dr Shaikh Adnan Rakib, Resident Assistant Professor, Department of Surgery, Bangladesh Medical College & Hospital, Dhanmondi, Dhaka, Bangladesh; E-mail:
Mymensingh Med J. 2018 Jul;27(3):585-595.
Thyroid cancer is the most frequent cancer among endocrine tumors, and account for approximately 1% of all malignancies. Recent literature has suggested an association between autoimmune thyroiditis and papillary thyroid cancer. The aim of the study was to choose the role of preoperative thyroid auto-antibodies as a predictive marker that could distinguish benign and malignant thyroid nodules and any other occult malignancy. This cross sectional study was done from July 2012 to June 2014 in department of Surgery Sir Salimullah Medical College & Mitford Hospital (SSMC&H) in collaboration with department of Otolaryngology SSMC&H, Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College and Bangladesh Medical College of Dhaka city. Inclusion criteria were all patients presenting with thyroid swelling. For this study, 116 patients of thyroid swelling were studied by detailed history, clinical examination, thyroid hormone assay (serum T₃, T₄, TSH), ultrasonogram to detect single or multiple nodules, solid or cystic condition of nodules, thyroid scan to see functional status of gland, FNAC to detect benign or malignant condition preoperatively, thyroid auto antibodies (Tg-Ab and TPO-Ab) and histopathological examinations. FNAC outcomes were compared with anti-thyroid auto antibodies (ATA) and histopathological reports. In this study it showed that out off 89 benign classes 53 were with raised and 36 were with normal anti-thyroid auto anti-bodies (Tg-Ab+TPO-Ab). Among the raised 53 patient only 14(26.41%) were proved malignant in histopathological examination. On the other hand out off 36 normal anti-thyroid auto anti-bodies (Tg-Ab+TPO-Ab), 5(13.88%) became malignant histopathologically. In the cytological malignant group out off 17 patient 8 (47.05%) were with normal anti-thyroid auto anti-bodies (Tg-Ab+TPO-Ab) and 09(52.95%) were with raised anti-thyroid auto anti-bodies (Tg-Ab+TPO-Ab) and all of them were histologically malignant. It was observed that FNAC with high level of anti-thyroid auto anti-bodies (Tg-Ab+TPO-Ab) will be suspicious for malignancy but not statistically significant in this study odds ratio for anti-thyroid auto anti-bodies (Tg-Ab+TPO-Ab) within normal and raised were 0.78(0.501-1.214) and 1.23(0.807-1.89) respectively. In the series sensitivity, specificity, positive predictive value and negative predictive value of thyroid auto antibodies and FNACs were done by the ROC curve. It showed that PPV was highest 96% for FNAC and for Tg-Ab and TPO-Ab it was 27% and 24% respectively. In this study thyroid auto-antibodies were raised in both benign and malignant conditions. TPO-Ab was more raised than Tg-Ab in our country with malignant conditions of thyroid. Thyroid auto anti-bodies could not predict the malignant condition of thyroid. In our study the benign cytology with raised antithyroid auto antibodies showed risk to be malignant outcome in histopathology.
甲状腺癌是内分泌肿瘤中最常见的癌症，约占所有恶性肿瘤的1%。近期文献表明自身免疫性甲状腺炎与甲状腺乳头状癌之间存在关联。本研究的目的是探讨术前甲状腺自身抗体作为预测指标在鉴别甲状腺良恶性结节及其他隐匿性恶性肿瘤中的作用。这项横断面研究于2012年7月至2014年6月在萨利姆ullah爵士医学院和米特福德医院（SSMC&H）外科进行，与达卡市的班加班杜·谢赫·穆吉布医科大学、达卡医学院和孟加拉国医学院耳鼻喉科合作。纳入标准为所有出现甲状腺肿大的患者。本研究对116例甲状腺肿大患者进行了详细的病史、临床检查、甲状腺激素测定（血清T₃、T₄、TSH）、超声检查以检测单个或多个结节、结节的实性或囊性情况、甲状腺扫描以观察腺体功能状态、细针穿刺抽吸活检（FNAC）以术前检测良性或恶性情况、甲状腺自身抗体（Tg-Ab和TPO-Ab）以及组织病理学检查。将FNAC结果与抗甲状腺自身抗体（ATA）和组织病理学报告进行比较。本研究显示，在89例良性病例中，53例抗甲状腺自身抗体（Tg-Ab+TPO-Ab）升高，36例正常。在53例抗体升高的患者中，组织病理学检查仅14例（26.41%）被证实为恶性。另一方面，在36例抗甲状腺自身抗体（Tg-Ab+TPO-Ab）正常的患者中，5例（13.88%）组织病理学检查为恶性。在17例细胞学恶性组患者中，8例（47.05%）抗甲状腺自身抗体（Tg-Ab+TPO-Ab）正常，9例（52.95%）抗甲状腺自身抗体（Tg-Ab+TPO-Ab）升高，且所有患者组织学均为恶性。观察到抗甲状腺自身抗体（Tg-Ab+TPO-Ab）水平高的FNAC对恶性肿瘤具有可疑性，但在本研究中无统计学意义，正常和升高的抗甲状腺自身抗体（Tg-Ab+TPO-Ab）的比值比分别为0.78（0.501-1.214）和1.23（0.807-1.89）。通过ROC曲线对该系列中甲状腺自身抗体和FNAC的敏感性、特异性、阳性预测值和阴性预测值进行了分析。结果显示，FNAC的阳性预测值最高，为96%，Tg-Ab和TPO-Ab的阳性预测值分别为27%和24%。本研究中，甲状腺自身抗体在良性和恶性情况下均升高。在我国甲状腺恶性情况下，TPO-Ab比Tg-Ab升高更明显。甲状腺自身抗体不能预测甲状腺的恶性情况。在我们的研究中，抗甲状腺自身抗体升高的良性细胞学检查显示组织病理学有恶性结局的风险。
