甲狀腺結節診斷方法之評估

Evaluation of Diagnostic Methods in Thyrid Nodules

邱煥仁(Huan-Jen Chiu) ； 郭文烈(Wen-Rei Kuo) ； 江豐裕(Feng-Yu Chiang) ； 李家和(Ka-Wo Lee)

《中華民國耳鼻喉科醫學雜誌》 37卷6期 (2002/10) Pp. 407-412

https://doi.org/10.6286/2002.37.6.407

摘要

背景：甲狀腺結節相當普遍，其檢查方法種類繁多，包括針吸細胞學檢查、超音波檢查、核子掃描檢查、電腦斷層和抽血檢查等。如何以經濟而有效的方法來診斷甲狀腺結節是否為惡性，顯得非常重要。因此我們將探討診斷惡性之方法以何種較好。
方法：從1993年1月至1999年10月共有310名甲狀腺結節患者在本科接受開刀治療。以回溯的方式，分析病歷記錄，包括年齡、性別、診斷方法和病理結果，並探討針吸細胞學檢查、超音波檢查、核子掃描檢查在甲狀腺結節的診斷角色。
結果：310名患者中，70名為惡性，而且以乳頭狀癌最多（佔惡性中84.3%）。167名患者接受針吸細胞學檢查，其敏感度82.1%、特異性92.2%、準確度89.8%；281名接受超音波檢查，其敏感度64.4%、特異性94.1%、準確度87.9%；273名接受核子掃描檢查，其敏感度81.4%、特異性17.8%、準確度31.5%。
結論：甲狀腺結節不算少見，因此對於甲狀腺結節的診斷相當重要。就單一項檢查而言，３種檢查中，以針吸細胞學檢查具有準確性高、費用便宜且操作方便等優點，足以作為甲狀腺結節的主要診斷工具。

關鍵字

甲狀腺結節 ； 診斷方法 ； 針吸細胞學檢查 ； 超音波檢查 ； 核子掃描檢查

並列摘要

BACKGROUND: While thyroid nodules are quite common, occurring at least in 4%-7% of the population, most of them are benign. The incidence of malignancy in these nodules is quite low. However, how to diagnose the malignant lesion of thyroid nodule is very important. The aim of this study was to assess retrospectively the value of fine needle aspiration, ultrasonography and thyroid nuclear scan in the preoperative investigation of patients with thyroid nodule.
METHODS: From January 1993 to October 1999, 310 patients visited our institution because of thyroid nodules. A retrospective study was performed to determine the reliability of fine needle aspiration cytology (FNAC), ultrasonography (US) and thyroid nuclear scan in the evaluation of thyroid nodule.
RESULTS: Of 310 patients studied, 70 were found to have malignant lesions, most of which were papillary carcinoma. FNAC was performed on 167 patients with thyroid disease, US was performed on 281 patients with thyroid nodule, and thyroid nuclear scan was performed on 273 patients with thyroid disease. The sensitivities of FNAC, US and nuclear scan for malignancy were 82.1%, 64.4% and 81.4%, respectively. The specificities of FNAC, US and nuclear scan were 92.2%, 94.1% and 17.8%, respectively.
CONCLUSIONS: Although thyroid nodules are common, few prove to be malignant. Nevertheless, such malignancy is very important to diagnose. Because of FNAC's accuracy, simplicity and low cost, it can virtually replace US and nuclear scan as the primary diagnostic procedure in the evaluation of the patient with thyroid nodule.

並列關鍵字

thyroid nodule ； diagnostic method ； fine needle aspiration cytology ； sonography ； scintigraphy