Correlation of Ultrasonography with Fine Needle Aspiration Cytology and Final Pathological Diagnoses in Patients with Thyroid Nodules

甲狀腺超音波合併細針抽吸細胞學與最終病理診斷在甲狀腺結節的相關性

陳寶印(Pao-Yin Chen) ； 邱世欽(Shyh-Ching Chiou) ； 葉曉芸(Hsiao-Yun Yeh) ； 陳嘉珮(Chia-Pei Chen) ； 何正(Chen Ho) ； 林仁德(Jen-Der Lin) ； 謝清川(Ching-Chuan Hsieh) ； 李錦輝(Kam-Fai Lee) ； 彭雲杏(Yun-Shing Peng)

《中華放射線醫學雜誌》 35卷1期 (2010/03) Pp. 1-7

摘要

本研究目的為評估甲狀腺超音波合併細針抽吸細胞學與最終病理結果的相關性。
收集2006年1月至2008年2月共1725位本院病患接受甲狀腺超音波檢查。102位(5.9%)病患接受手術。在102位病患當中，有九十位接受細針抽吸細胞學檢查。細針抽吸細胞學檢查結果分成四類：惡性、良性、不確定與不滿意。將甲狀腺超音波、細針抽吸細胞學與最終病理結果相關性做評估。
在102位病患中，年齡從13歲至79歲（平均45.5±15.3歲），女性與男性比例為5.4比1。78位病患診斷為良性(76.5%)，24位病患診斷為惡性(23.5%)（乳突癌20例，未分化癌1例，髓質癌1例與轉移癌2例）。90位接受超音波及細針抽吸細胞學檢查。細針抽吸細胞學檢查偵測惡性的陽性診斷率為94.7%（18/19例）、陰性診斷率為93%（66/71例）、敏感性為78.3%（18/23例）、特異性為98.5%（66/67例）。超音波合併細針抽吸細胞學檢查偵測惡性的陽性診斷率為94.7%（18/19例）、陰性診斷率為92.8%（77/83例）、敏感性為75%、特異性為98.7%。16例細胞學報告為不確定病例當中，有3例診斷為惡性(18.7%)。囊性病灶當中有4.7%（1/21例）診斷為惡性。1例乳突性微小癌合併頸部淋巴結轉移顯示只有微小鈣化點存在於甲狀腺實質中。
甲狀腺超音波與細針抽吸細胞學檢查在甲狀腺結節初始的評估是有用的。不確定病例應該考慮手術治療。此外我們應注意瀰漫性結節中的微小鈣化合併頸部淋巴節腫大。

並列摘要

The aim of this study was to evaluate the relationship of the combined use of ultrasonography (US) and fine needle aspiration cytology (FNAC) with final pathological results in patients with thyroid nodules.
We retrospectively reviewed data from 1,725 patients who had received US examination at our institution between January 2006 and February 2008. Of these patients, 102 (5.9%) had undergone surgical treatment, 90 of whom were also examined by FNAC. The results of FNAC were categorized into 4 groups: malignant, benign, indeterminate and unsatisfactory. We then evaluated the correlations between diagnosis and thyroid US, FNAC, and final pathological results.
The age of the 102 patients who received surgery ranged from 13 to 79 years (mean age, 45.5 ± 15.3 years). The female: male ratio was 5.4:1. Seventy-eight patients were diagnosed as having benign lesions (76.5%) and 24 patients as having a malignancy (23.5%), including 20 papillary cancers, 1 anaplastic cancer, 1 medullary cancer and 2 metastatic cancers. Ninety patients received FNAC after US. The positive predictive value for detection of malignancy using FNAC was 94.7% (18/19 cases) and the negative predictive value was 93% (66/71 cases). The sensitivity of the cytological diagnosis was 78.3% (18/23 cases) and the specificity was 98.5% (66/67 cases). The overall positive predictive value for malignancy using both thyroid US and FNAC was 94.7% (18/19 cases) and the negative predictive value, 92.8% (77/83 cases). The sensitivity of the combined investigations was 75% (18/24 cases) and the specificity, 98.7% (77/78 cases). Of the 16 indeterminate cytological cases, 3 were diagnosed as having a malignant lesion (18.7%). In patients with cystic lesions, 4.7% of cases (1/21 cases) were diagnosed as malignant. One patient with a papillary microcarcinoma with neck lymph node metastasis had only a tiny calcified spot in the parenchyma of the thyroid.
US with FNAC is useful in the initial evaluation of thyroid nodules. Surgical treatment should be considered for indeterminate cases. It is also important to pay attention to microcalcification in diffuse goiters, especially in patients with neck lymph node enlargement.