^(99m)Tc-MIBI显像与细针活检对甲状腺“冷结节”鉴别诊断的对比研究  

Comparative study on differentiating benign from malignant“thyroid cold nodules” with 99mTc- MIBI imaging and Fine-Needle aspiration cytology

作　　者：苏镇军 孙立尧[1] 苏计恩 王京涛[1] 孔凡英[1] 郭占景[2] 

机构地区：[1]邯郸钢铁集团有限责任公司职工医院,河北邯郸056001 [2]河北省石家庄市疾病预防控制中心,河北石家庄050001

出　　处：《现代中西医结合杂志》2013年第24期2632-2634,2646,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的探讨99 mTc-MIBI亲肿瘤显像与超声引导甲状腺细针吸取细胞学活检(FNAC)对甲状腺"冷结节"良性与恶性鉴别诊断的临床应用价值。方法选取59例"冷结节"甲状腺疾病患者进行99 mTc-MIBI亲肿瘤显影和超声引导细针吸取细胞学活检细胞病理检查,对2种检查结果进行统计分析。结果甲状腺"冷结节"恶性结节为19例,恶性患病率为32%;99 mTc-MIBI亲肿瘤显像对甲状腺"冷结节"良恶性鉴别的灵敏度、特异度、约登指数、准确度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为73.68%,72.50%,46.18%,72.88%,56.00%,85.29%,3.15和0.49,与组织病理学诊断金标准一致性为中度符合(Kappa=0.43,P=0.001);细针吸取细胞学活检(FNAC)对甲状腺"冷结节"良恶性鉴别的灵敏度、特异度、约登指数、准确度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为84.21%,95.00%,79.21%,94.91%,88.89%,92.68%,16.84和0.35,与组织病理学诊断金标准一致性为高度符合(Kappa=0.80,P=0.000);FNAC与99 mTc-MIBI一致性为中度符合(Kappa=0.531,P=0.000),2种方法的阳性率无显著性差异(P>0.05)。结论甲状腺实性"冷结节"恶性率较高;超声引导甲状腺FNAC与组织病理学诊断金标准一致性比较高;FNAC较99 mTc-MIBI亲肿瘤显像对甲状腺"冷结节"的良恶性鉴别诊断更有临床应用价值。Objective It is to approach the clinical value of ^99mTc - MIBI tumor avid imaging and ultrasound guidance Fine-Needle aspiration cytology （FNAC） on differentiating benign from malignant ＂thyroid cold nodules＂. Methods 59 patients with ＂thyroid cold nodules＂ were chosen to examine with ^99mTe-MIBI imaging and FNAC, of which results were analyzed. Results 19 cases were malignant nodules, of which prevalence accounted for 32%. Sensitivity（Se） , specificity（Sp） , Youden＇s index, accuracy, positive predictive value （ ＋ PV） , negative predictive value （ - PV） , positive likelihood ratio （ ＋ LR） , negative likelihood ratio（ - LR） of 99mTc - MIBI for differentiating benign ＂thyroid cold nodules＂ from malignant one were 73.68% , 72.50% , 46.18% , 72.88% , 56.00% , 85.29% , 3.15 and 0.49, of which consistency rate with gold standard was middle level （Kappa =0.43, P = 0.001）. Sp, Youden＇ s index, accuracy, ＋ PV, - PV, ＋ LR, - LR of FNAC for differentiating benign ＂solid and cold thyroid nodules＂ from malignant one were 84.21%, 95.00%, 79.21%, 94.91% , 88.89% , 92.68% , 16.84 and 0.35, of which consistency rate with gold standard was high level （ kappa = 0.80, P = 0. 000）. Consistency rate of FNAC with ^99mTC - MIBI was middle level （ Kappa = 0.531 , P = 0. 000）. There was no significant difference between FNAC and ^99mTc - MIBI （ P 〉 0.05 ）. Conclusion Malignant rate of cold thyroid nodules was high-er. Consistency rate of FNAC with ^99mTc - MIBI was higher. Both of the methods have important clinic value to differentiating benign ＂thyroid cold nodules＂ from malignant one.

关 键 词：甲状腺冷结节 99 m锝-甲氧基异丁基异腈 细针吸取细胞学活检 

分 类 号：R322.51[医药卫生—人体解剖和组织胚胎学]