细针穿刺、超声及甲状腺球蛋白对分化型甲状腺癌清甲后颈部肿大淋巴结诊断价值的比较  

Comparison of fine-needle aspiration cytology, ultrasound and thyroglobulin examination for the differential diagnosis of enlarged neck lymph nodes in patients with differentiated thyroid cancer after radioactive iodine remnant ablation

作　　者：卢承慧 左书耀[1] 王登春[1] 王叙馥[1] 王国明[1] 

机构地区：[1]青岛大学医学院附属医院核医学科,266003

出　　处：《中华核医学与分子影像杂志》2014年第4期283-286,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：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.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

关 键 词：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 

分 类 号：R736.1[医药卫生—肿瘤]