Norton L W, Wangensteen S L, Davis J R, Paplanus S H, Werner S C
Surgery. 1982 Oct;92(4):700-5.
The utility of fine-needle aspiration biopsy to detect carcinoma in thyroid nodules was evaluated by a decision-analysis approach in 102 patients. The procedure caused no morbidity. Cytologic diagnoses were categorized as unsatisfactory (4), no abnormality detected (61), atypical (13), suspicious for malignancy (14), malignancy (2), and inflammation (8). The duration of follow-up averaged 13 months. Of 21 thyroidectomy patients, 10 (48%) had carcinoma. Half of the ten patients operated upon for suspicious cytologic findings were found to have malignancy. Assuming criterion I, that atypical, suspicious, or malignancy results indicated cancer, sensitivity was 90%, specificity 77%, false positive fraction 23%, positive predictive value 31%, negative predictive value 99%, and accuracy 79%. Assuming criterion II, that only suspicious or malignancy cytologic findings represented carcinoma, sensitivity was 70%, specificity 90%, false positive fraction 10%, positive predictive value 44%, negative predictive value 96%, and accuracy 88%. We conclude that sensitivity and specificity of fine-needle aspiration biopsy vary depending upon the use of criterion I or II. Accuracy is highest if atypical results are not considered to represent carcinoma. Positive predictive values remain low and negative predictive values are high in either case. The utility of fine-needle aspiration biopsy when interpreted in relation to clinical criteria is supported by these results.
采用决策分析方法对102例患者进行细针穿刺活检以检测甲状腺结节中的癌的效用进行了评估。该操作未引起任何并发症。细胞学诊断分为不满意（4例）、未检测到异常（61例）、非典型（13例）、可疑恶性（14例）、恶性（2例）和炎症（8例）。随访时间平均为13个月。在21例行甲状腺切除术的患者中，10例（48%）患有癌。因细胞学检查结果可疑而接受手术的10例患者中，有一半被发现患有恶性肿瘤。假设标准I，即非典型、可疑或恶性结果表明为癌症，则敏感性为90%，特异性为77%，假阳性率为23%，阳性预测值为31%，阴性预测值为99%，准确性为79%。假设标准II，即只有可疑或恶性细胞学检查结果代表癌症，则敏感性为70%，特异性为90%，假阳性率为10%，阳性预测值为44%，阴性预测值为96%，准确性为88%。我们得出结论，细针穿刺活检的敏感性和特异性因使用标准I或II而异。如果不认为非典型结果代表癌症，则准确性最高。在任何一种情况下，阳性预测值仍然较低，而阴性预测值较高。这些结果支持了细针穿刺活检结合临床标准进行解读时的效用。
