Hocevar M, Auersperg M
Institute of Oncology, Ljubljana, Slovenia.
Eur J Surg Oncol. 1998 Dec;24(6):553-7. doi: 10.1016/s0748-7983(98)93644-7.
There is no reliable diagnostic test for pre-operative differentiation between benign and malignant follicular and Hurthle cell neoplasms. Measurements of serum thyroglobulin (Tg) are currently only used post-operatively as a marker of recurrent disease or distant metastases in the follow-up of patient with differentiated thyroid cancer. In this study pre-operative serum Tg measurements were performed with the aim of investigating whether Tg levels differ in benign and malignant follicular and Hurthle cell neoplasms.
In 516 patients who underwent thyroid surgery at the Institute of Oncology in Ljubljana, Slovenia, from 1990 to 1996, serum Tg concentration was measured in addition to the standard pre-operative tests (fine-needle aspiration biopsy, ultrasonography, 99mTc scanning and hormonal profile). After the operation, patients were divided into 11 groups based on their histological diagnosis (papillary cancer--classic, papillary cancer--follicular variant, papillary cancer oncocytic variant, occult papillary cancer, follicular adenoma, follicular cancer, Hurthle cell adenoma, Hurthle cell cancer, anaplastic cancer, medullary cancer, nodular goiter) and the serum Tg values of the different groups were compared.
In groups of patients with follicular and Hurthle cell cancer, median Tg values were higher (2895 and 638.5 ng/ml) and, statistically, differed significantly from the serum Tg values in all other groups (P<0.01). Sensitivities and specificities of the tests were 71.8% and 80.4% for follicular cancer and 55.6% and 83.8% for Hurthle cell cancer, while positive and negative predictive values were 75.6% and 77.1% for follicular cancer and 75% and 68.4% for Hurthle cell cancer.
These results indicate that pre-operative serum Tg measurements might be an important additional diagnostic tool in the pre-operative work-up of patients with thyroid tumours.
目前尚无可靠的诊断方法用于术前鉴别滤泡性和许特耳细胞肿瘤的良恶性。血清甲状腺球蛋白（Tg）检测目前仅在术后用于分化型甲状腺癌患者随访中作为疾病复发或远处转移的标志物。本研究进行术前血清Tg检测，旨在调查良性和恶性滤泡性及许特耳细胞肿瘤患者的Tg水平是否存在差异。
1990年至1996年在斯洛文尼亚卢布尔雅那肿瘤研究所接受甲状腺手术的516例患者，除进行标准术前检查（细针穿刺活检、超声检查、99mTc扫描和激素水平检测）外，还检测了血清Tg浓度。术后，根据组织学诊断将患者分为11组（乳头状癌——经典型、乳头状癌——滤泡状变异型、乳头状癌嗜酸性细胞变异型、隐匿性乳头状癌、滤泡性腺瘤、滤泡癌、许特耳细胞腺瘤、许特耳细胞癌、未分化癌、髓样癌、结节性甲状腺肿），并比较不同组的血清Tg值。
在滤泡性和许特耳细胞癌患者组中，Tg中位数较高（分别为2895和638.5 ng/ml），且在统计学上与所有其他组的血清Tg值有显著差异（P<0.01）。滤泡癌检测的敏感性和特异性分别为71.8%和80.4%，许特耳细胞癌分别为55.6%和83.8%，而滤泡癌的阳性和阴性预测值分别为75.6%和77.1%，许特耳细胞癌分别为75%和68.4%。
这些结果表明，术前血清Tg检测可能是甲状腺肿瘤患者术前检查中一项重要的辅助诊断工具。
