鎝－99m－過鎝酸鈉核醫唾腺掃描診斷腮腺Warthin氏腫瘤及瘤細胞症之可信度探討

背景：鎝-99m過鎝酸鈉攝影在教科書中仍被列為腮腺腫瘤之鑑別診斷工具之一。當結果呈現陽性，一般即認為屬Warthin氏腫瘤或癌細胞症（oncocytosis）。回顧文獻，並未特別討論此項檢查之可信度。本研究收集術前接受核醫掃描檢查之病例，並對照術後之病理診斷作一探討。方法：從1988年1月至2000年12月，經由回溯性病歷收集腮腺腫瘤手術病例，其於術前皆接受放射線同位素鎝攝影，且術後皆具完整病理診斷之病例資料。比對病理診斷及術前核醫掃描結果，若屬偽陰性或偽陽性，則對其病理診斷及影像診斷之資料作進一步分析。結果：共33例，男性23例，女性10例；平均年齡51.2歲。術前核醫掃描陽性者共有18例，最後病理證實15例為Warthin氏腫瘤，1例為瘤細胞症，1例為淋巴上皮樣癌（lymphoepithelioma-like carcinoma），1例為良性混合瘤（mixed tumor）。術前核醫掃描陰性者共有15例，最後病理證實1例為Warthin氏腫瘤，1例為瘤細胞症，另外13例為其它良、惡性病灶。唾液腺核醫掃描診斷Warthin氏腮腺腫瘤或瘤細胞症的敏感率為88.9%，特異診斷率為86.7%，準確率87.9%，偽陰性率6.1%，偽陽性率6.1%，陽性預測值88.9%，陰性預測值86.7%。結論：以核醫掃描陽性結果診斷Warthin氏腮腺腫瘤或瘤細胞症雖然有高敏感率、特異診斷率、陽性預測值、陰性預測值及準確率，但仍需小心排除惡性之可能性。

關鍵字

腮腺腫瘤；核醫掃描；敏感率；特異診斷率； Warthin氏腫瘤；瘤細胞症

並列摘要

BACKGROUND: Tc-99m pertechnetate scan is generally accepted that a positive result is highly indicative of Warthin's tumor or oncocytosis. Few reports have discussed the reliability of this examination in patients with these conditions. This study determined the reliability of the detection of the Warthin's tumor and oncocytosis by Tc-99m pertechnetate scan. METHODS: Cases of parotid tumor treated between January 1988 and December 2000 were reviewed. All cases had undergone pre-operative Tc-99m pertechnetate scan and had pathological results. The radionuclide scan and the pathology results were compared. If false negative or false positive result was obtained, both the original pathology and the radionuclide scan data were reviewed. RESULTS: A total of 33 cases were included, with 23 male and 10 female. The mean age was 51.2-year-old. There were 18 cases with a positive radionuclide scan; 15 cases with pathological proof of Warthin's tumor; one case with oncocytosis; one with lymphoepithelioma-like carcinoma and the remaining case had a mixed tumor. There were 15 cases with a negative radionuclide scan. Pathological proof of Warthin’s tumor was obtained in one case and of oncocytosis in one case, while the remaining 13 cases were other benign or malignant lesions. The reliability of Tc-99m pertechnetate scan in the diagnosis of Warthin's tumor and oncocytosis were calculated. The sensitivity was 88.9%, the specificity was 86.7%, the accuracy was 87.9%, the false negative rate was 6.1%, the false positive rate was 6.1%, the positive predictive value was 88.9% and the negative predictive value was 86.7%. CONCLUSION: Though a high sensitivity, specificity, accuracy, positive and negative predictive value of the Tc-99m pertechnetate scan for Warthin's tumor and oncocytosis of the parotid tumor were achieved, these values were still less than 100%. Care should always be taken to exclude any possible malignancy.

並列關鍵字

parotid tumor ； radionuclide scan ； sensitivity ； specificity ； Warthin's tumor ； oncocytosis

國際替代計量

鎝－99m－過鎝酸鈉核醫唾腺掃描診斷腮腺Warthin氏腫瘤及瘤細胞症之可信度探討

全文下載

主題瀏覽