Sarda A K, Gupta A, Jain P K, Prasad S
Department of Surgery, Maulana Azad Medical College, New Delhi, India.
Postgrad Med J. 1997 Sep;73(863):560-4. doi: 10.1136/pgmj.73.863.560.
An analysis of management of 546 cases of solitary thyroid nodules in an endemic area is presented. None of the evaluating procedures could effectively isolate benign from malignant disease. Of 508 cases considered clinically to be benign, 42 harboured malignancy on histological examination whereas of the 38 cases suspected clinically to be malignant, 21 were histologically benign. 131I-Thyroid scanning also lacked sensitivity in identifying malignant nodules since the prevalence of malignancy in cases which were 'cold' (44/316) was not significantly different from that amongst the 'uniform' cases (15/142). Fine-needle aspiration cytology, although the most sensitive and specific evaluating modality, did not decrease the number of operations for solitary thyroid nodules nor did it increase the incidence of malignancy amongst the operated cases, because of its limitations in differentiating benign from malignant follicular neoplasms. The conditions under which surgery was advocated are described.
本文对某流行地区546例甲状腺单发结节的管理情况进行了分析。没有一种评估方法能够有效地将良性疾病与恶性疾病区分开来。在临床诊断为良性的508例病例中，有42例经组织学检查发现存在恶性肿瘤；而在临床怀疑为恶性的38例病例中，有21例经组织学检查为良性。131I甲状腺扫描在识别恶性结节方面也缺乏敏感性，因为“冷”结节（44/316）中的恶性肿瘤患病率与“均匀”结节（15/142）中的患病率没有显著差异。细针穿刺细胞学检查虽然是最敏感和特异的评估方式，但由于其在区分良性和恶性滤泡性肿瘤方面存在局限性，既没有减少甲状腺单发结节的手术数量，也没有增加手术病例中的恶性肿瘤发生率。文中描述了提倡手术的情况。
