Boyd L A, Earnhardt R C, Dunn J T, Frierson H F, Hanks J B
Department of Surgery, University of Virginia Health Sciences Center, Charlottesville 22906, USA.
J Am Coll Surg. 1998 Nov;187(5):494-502. doi: 10.1016/s1072-7515(98)00221-x.
We sought to evaluate the predictive value of preoperative fine-needle aspiration (FNA) on surgical decision making by evaluating the final pathologic diagnosis and comparing it to the preoperative diagnosis. Further, we wished to calculate the predictive accuracy of each of several types of preoperative FNA diagnosis.
A retrospective chart review of 151 thyroid resections between July 1990 and April 1996 at the University of Virginia was undertaken. The mean age was 45 years (range, 11 to 85 years). Preoperative laboratory values, presenting symptoms, imaging studies, and predictive values of preoperative FNA and intraoperative frozen section were analyzed.
Symptomatology was poorly predictive of a benign versus malignant postoperative final pathologic diagnosis. Sensitivity, specificity, and accuracy of frozen section versus FNA was 86% versus 86%; 99% versus 93%, and 96% versus 92%, respectively, if the reading "cancer" or "suspicious" were predicted as positive for malignancy and "benign" or "follicular" were predicted as negative for malignancy. If only the reading "cancer" was predicted as positive for malignancy and only "benign" was predicted as negative for malignancy, sensitivity and specificity for FNA were 100% and 96%, respectively, and 100% and 99%, respectively, for frozen section. Forty-nine "follicular" lesions obtained by preoperative FNA resulted in 46 benign diagnoses after surgical resection.
The use of preoperative FNA is a powerful diagnostic tool in the hands of skilled pathologists. There is increasing evidence that intraoperative frozen section adds little to intraoperative decision making in patients diagnosed with thyroid cancer by preoperative FNA. Less definitive interpretations decrease the sensitivity, specificity, and accuracy of the FNA diagnosis.
我们试图通过评估最终病理诊断并将其与术前诊断进行比较，来评估术前细针穿刺抽吸活检（FNA）对手术决策的预测价值。此外，我们希望计算几种术前FNA诊断类型各自的预测准确性。
对1990年7月至1996年4月在弗吉尼亚大学进行的151例甲状腺切除术进行回顾性图表分析。平均年龄为45岁（范围11至85岁）。分析术前实验室检查值、临床表现、影像学检查以及术前FNA和术中冰冻切片的预测价值。
症状学对术后良性与恶性最终病理诊断的预测性较差。如果将“癌症”或“可疑”解读为恶性阳性，“良性”或“滤泡性”解读为恶性阴性，冰冻切片与FNA的敏感性、特异性和准确性分别为86%对86%；99%对93%，以及96%对92%。如果仅将“癌症”解读为恶性阳性，仅将“良性”解读为恶性阴性，FNA的敏感性和特异性分别为100%和96%，冰冻切片分别为100%和99%。术前FNA获得的49个“滤泡性”病变在手术切除后有46个诊断为良性。
在技术熟练的病理学家手中，术前FNA是一种强大的诊断工具。越来越多的证据表明，对于术前FNA诊断为甲状腺癌的患者，术中冰冻切片对术中决策的帮助不大。不太明确的解读会降低FNA诊断的敏感性、特异性和准确性。
