Department of Endocrinology, Diabetology, and Metabolism, Lille University Hospital, Lille, France; Inserm, U 1172, Lille University, Lille, France.
Department of Nuclear Medicine, Lille University Hospital, Lille, France.
Ann Endocrinol (Paris). 2021 Apr;82(2):83-91. doi: 10.1016/j.ando.2021.03.003. Epub 2021 Mar 13.
The aim of this study was to evaluate the role of dual isotope Iodine/Tc-MIBI thyroid scintigraphy (IMS) in discriminating between malignant and benign lesions in indeterminate nodules using quantitative analysis methods.
Thirty-five consecutive patients with thyroid nodules of indeterminate or non-diagnostic cytology and cold on Iodine scintigraphy (10 Bethesda I, 24 Bethesda III-IV, 1 in which cytology was impossible) underwent IMS between 2017 and 2019 with uptake quantification at two time points ahead of thyroidectomy: early and late. Images were analyzed by two blinded physicians.
Twelve nodules were malignant and 23 benign on histopathology. Mean uptake values were lower in benign than in malignant nodules at both time points: early, 8.7±4.1 versus 12.9±3.5 (P=0.005); and late, 5.3±2.7 versus 7.7±1.1 (P=0.008). Interobserver reproducibility was excellent. The intraclass correlation coefficient was 0.86 in benign and 0.92 in malignant lesions for early uptake result (ER) and 0.94 and 0.85 respectively for late uptake result (LR). The optimal LR cut-off to exclude a diagnosis of malignancy was set at 5.9 . The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of this cut-off were, respectively, 100%, 65.2%, 60%, 100% and 77.1%.
Despite some study limitations, quantitative analysis of Tc-MIBI thyroid scintigraphy had a good reproducibility, which could help to rule out malignancy in non-diagnostic or indeterminate thyroid nodules and thereby reducing the number of patients undergoing unnecessary surgery when LR is below 5.9.
本研究旨在使用定量分析方法评估双同位素碘/锝-MIBI 甲状腺闪烁扫描（IMS）在区分甲状腺不定型或非诊断性细胞学结节的良恶性病变中的作用。
2017 年至 2019 年期间，连续 35 例甲状腺结节患者（10 例 Bethesda I 级、24 例 Bethesda III-IV 级、1 例细胞学检查无法进行）行 IMS，在甲状腺切除术前两个时间点进行摄取量定量分析：早期和晚期。图像由两名盲法医生进行分析。
12 个结节为恶性，23 个为良性。在两个时间点，良性结节的摄取值均低于恶性结节：早期为 8.7±4.1 比 12.9±3.5（P=0.005）；晚期为 5.3±2.7 比 7.7±1.1（P=0.008）。观察者间的重复性极好。良性病变的早期摄取结果（ER）的组内相关系数为 0.86，恶性病变的 ER 为 0.92；晚期摄取结果（LR）的组内相关系数分别为 0.94 和 0.85。排除恶性诊断的最佳 LR 截断值设定为 5.9。该截断值的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 100%、65.2%、60%、100%和 77.1%。
尽管存在一些研究限制，但 Tc-MIBI 甲状腺闪烁扫描的定量分析具有良好的可重复性，当 LR 低于 5.9 时，有助于排除非诊断性或不定型甲状腺结节的恶性病变，从而减少不必要手术的患者数量。
