中华核医学与分子影像杂志
中華覈醫學與分子影像雜誌
중화핵의학여분자영상잡지
Chinese Journal of Nuclear Medicine and Molecular Imaging
2014年
4期
283-286
,共4页
卢承慧%左书耀%王登春%王叙馥%王国明
盧承慧%左書耀%王登春%王敘馥%王國明
로승혜%좌서요%왕등춘%왕서복%왕국명
甲状腺肿瘤%淋巴结%活组织检查,细针%超声检查%甲状腺球蛋白
甲狀腺腫瘤%淋巴結%活組織檢查,細針%超聲檢查%甲狀腺毬蛋白
갑상선종류%림파결%활조직검사,세침%초성검사%갑상선구단백
Thyroid neoplasms%Lymph nodes%Biopsy,fine-needle%Ultrasonography%Thyroglobulin
目的 探讨DTC手术和131I治疗后细针穿刺细胞学(FNAC)检查对颈部肿大淋巴结定性诊断的价值,并与超声、Tg和TgAb检测作比较.方法 61例经手术和131I清除残余甲状腺组织(简称清甲)治疗后的DTC患者,经体格检查或超声检查发现颈部淋巴结肿大,随后1周内对可疑淋巴结行超声引导下FNAC检查,并将检查结果与同期超声、Tg和TgAb结果进行对比.最终诊断根据病理、治疗后131I全身显像(Rx-WBS)及临床随访作出.3种检查方法间诊断效能的比较采用x2检验和Fisher确切概率法.结果 61例患者中,共58例患者获FNAC诊断,3例不能定性,经综合评判,淋巴结恶性40例,良性18例.39例经FNAC检查确诊为恶性者中20例经手术切除,19例行131I清除转移灶治疗;FNAC与术后病理诊断符合率为100％ (20/20),与Rx-WBS的符合率为78.9％(15/19);19例经FNAC检查确诊为良性淋巴结者中15例持续随访3～6个月,余4例行131I治疗;FNAC与随访结果符合率为93.3％(14/15),与Rx-WBS均符合(4/4).FNAC检查、超声、Tg和TgAb检测诊断DTC转移淋巴结良恶性的灵敏度分别为97.5％ (39/40)、87.5％(35/40)、92.5％ (37/40),特异性分别为100％(18/18)、55.6％ (10/18)、72.2％ (13/18),准确性分别为98.3％(57/58)、77.6％(45/58)、86.2％(50/58);FNAC检查的准确性明显高于超声、Tg和TgAb(x2=4.336和11.697,均P＜0.05),而超声与Tg和TgAb检测之间准确性的比较差异无统计学意义(X2=1.450,P>0.05).超声与TS和TgAb检测结果一致者39例,与FNAC检查的符合率为97.4％ (38/39);超声与Tg和TgAb检测结果不一致者19例,经FNAC检查证实4例为恶性,15例为良性.结论 对DTC患者颈部肿大淋巴结的良恶性诊断,FNAC检查明显优于超声与Tg和TgAb检测.当随访中超声与Tg和TgAb结果不一致,可作为FNAC检查的应用指征.
目的 探討DTC手術和131I治療後細針穿刺細胞學(FNAC)檢查對頸部腫大淋巴結定性診斷的價值,併與超聲、Tg和TgAb檢測作比較.方法 61例經手術和131I清除殘餘甲狀腺組織(簡稱清甲)治療後的DTC患者,經體格檢查或超聲檢查髮現頸部淋巴結腫大,隨後1週內對可疑淋巴結行超聲引導下FNAC檢查,併將檢查結果與同期超聲、Tg和TgAb結果進行對比.最終診斷根據病理、治療後131I全身顯像(Rx-WBS)及臨床隨訪作齣.3種檢查方法間診斷效能的比較採用x2檢驗和Fisher確切概率法.結果 61例患者中,共58例患者穫FNAC診斷,3例不能定性,經綜閤評判,淋巴結噁性40例,良性18例.39例經FNAC檢查確診為噁性者中20例經手術切除,19例行131I清除轉移竈治療;FNAC與術後病理診斷符閤率為100％ (20/20),與Rx-WBS的符閤率為78.9％(15/19);19例經FNAC檢查確診為良性淋巴結者中15例持續隨訪3～6箇月,餘4例行131I治療;FNAC與隨訪結果符閤率為93.3％(14/15),與Rx-WBS均符閤(4/4).FNAC檢查、超聲、Tg和TgAb檢測診斷DTC轉移淋巴結良噁性的靈敏度分彆為97.5％ (39/40)、87.5％(35/40)、92.5％ (37/40),特異性分彆為100％(18/18)、55.6％ (10/18)、72.2％ (13/18),準確性分彆為98.3％(57/58)、77.6％(45/58)、86.2％(50/58);FNAC檢查的準確性明顯高于超聲、Tg和TgAb(x2=4.336和11.697,均P＜0.05),而超聲與Tg和TgAb檢測之間準確性的比較差異無統計學意義(X2=1.450,P>0.05).超聲與TS和TgAb檢測結果一緻者39例,與FNAC檢查的符閤率為97.4％ (38/39);超聲與Tg和TgAb檢測結果不一緻者19例,經FNAC檢查證實4例為噁性,15例為良性.結論 對DTC患者頸部腫大淋巴結的良噁性診斷,FNAC檢查明顯優于超聲與Tg和TgAb檢測.噹隨訪中超聲與Tg和TgAb結果不一緻,可作為FNAC檢查的應用指徵.
목적 탐토DTC수술화131I치료후세침천자세포학(FNAC)검사대경부종대림파결정성진단적개치,병여초성、Tg화TgAb검측작비교.방법 61례경수술화131I청제잔여갑상선조직(간칭청갑)치료후적DTC환자,경체격검사혹초성검사발현경부림파결종대,수후1주내대가의림파결행초성인도하FNAC검사,병장검사결과여동기초성、Tg화TgAb결과진행대비.최종진단근거병리、치료후131I전신현상(Rx-WBS)급림상수방작출.3충검사방법간진단효능적비교채용x2검험화Fisher학절개솔법.결과 61례환자중,공58례환자획FNAC진단,3례불능정성,경종합평판,림파결악성40례,량성18례.39례경FNAC검사학진위악성자중20례경수술절제,19례행131I청제전이조치료;FNAC여술후병리진단부합솔위100％ (20/20),여Rx-WBS적부합솔위78.9％(15/19);19례경FNAC검사학진위량성림파결자중15례지속수방3～6개월,여4례행131I치료;FNAC여수방결과부합솔위93.3％(14/15),여Rx-WBS균부합(4/4).FNAC검사、초성、Tg화TgAb검측진단DTC전이림파결량악성적령민도분별위97.5％ (39/40)、87.5％(35/40)、92.5％ (37/40),특이성분별위100％(18/18)、55.6％ (10/18)、72.2％ (13/18),준학성분별위98.3％(57/58)、77.6％(45/58)、86.2％(50/58);FNAC검사적준학성명현고우초성、Tg화TgAb(x2=4.336화11.697,균P＜0.05),이초성여Tg화TgAb검측지간준학성적비교차이무통계학의의(X2=1.450,P>0.05).초성여TS화TgAb검측결과일치자39례,여FNAC검사적부합솔위97.4％ (38/39);초성여Tg화TgAb검측결과불일치자19례,경FNAC검사증실4례위악성,15례위량성.결론 대DTC환자경부종대림파결적량악성진단,FNAC검사명현우우초성여Tg화TgAb검측.당수방중초성여Tg화TgAb결과불일치,가작위FNAC검사적응용지정.
Objective To compare the value of fine-needle aspiration cytology (FNAC),Tg,TgAb and ultrasonography (US) for the differential diagnosis of lymph node metastasis in patients with DTC after operation and radioactive iodine remnant ablation.Methods A total of 61 DTC patients with enlarged lymph nodes detected by US or physical examination after operation and radioactive iodine remnant ablation were included.FNAC was performed on the lymph nodes under US guidance within one week and the results were compared with those of Tg,TgAb and US.Final results were confirmed by comprehensive FNAC,posttreatment whole,body scan (Rx-WBS) and clinical follow-up.x2 test and Fisher's exact test were performed.Resuits Fifty-eight DTC patients had successful FNAC results,and 40 patients were confirmed as malignant and 18 as benign after overall assessment.FNAC identified 39 malignant and 19 benign cases.The coincidence rates of FNAC with postoperative pathological diagnosis and Rx-WBS for malignant cases were 100％ (20/20) and 78.9％ (15/19),respectively.For the benign cases,the coincidence rates of FNAC with clinical follow-up and Rx-WBS were 93.3％ (14/15)and 4/4,respectively.The sensitivity,specificity and accuracy were 97.5％(39/40),100％(18/18) and 98.3％(57/58) for FNAC; 87.5％(35/40),55.6％(10/18) and 77.6％(45/58) for US; 92.5％(37/40),72.2％(13/18) and 86.2％(50/58) for Tg combined with TgAb (Tg/TgAb).The accuracy of FNAC was higher than that of US and Tg/TgAb(x2 =4.336,11.697,both P＜0.05),while US and Tg/TgAb showed no significant difference (x2 =1.450,P＞0.05).Tg/TgAb and US results were consistent in 39 cases with a diagnostic accuracy of 97.4％ (38/39) verified by FNAC,while the other 19 cases with inconsistent Tg/TgAb and US results were verified as malignant in 4 cases and benign in 15 cases.Conclusions FNAC is superior to US and Tg/TgAb in the evaluation of lymph node metastasis in DTC patients after operation and radioactive iodine remnant ablation.FNAC should be recommended particularly when Tg/TgAb and US had inconsistent results.
