超声与超声联合核素显像诊断甲状腺结节的对比研究

目的评价超声显像和超声联合核素显像对甲状腺结节良恶性的诊断价值和意义.方法将110例手术切除的甲状腺结节患者的超声诊断和超声联合核素显像诊断分别与病理诊断结果进行回顾性分析.结果单纯超声诊断甲状腺结节的符合率为87.3%,超声联合核素显像的诊断符合率为90.9%.无论对良性结节或恶性结节,单纯超声诊断与超声联合核素显像诊断相比,两者差异无显著性(P＞0.05).结论对甲状腺结节的良恶性判断,超声联合核素显像与单纯超声诊断相比,并不能明显提高诊断符合率,超声检查仍应作为首选筛检方法.     

~(99m)Tc-MIBI显像对甲状腺单发结节的诊断价值

目的:探讨99mTc-MIBI显像对甲状腺单发结节鉴别诊断的临床价值.方法:对甲状腺99mTcO4-核素显像为单个"冷结节"的患者进行99mTc-MIBI显像,采集15min、30min及2h三时相的静态图像,将显像结果进行定量分析并与病理结果比较.结果:甲状腺癌组三时相的99mTc-MIBI摄取比值皆高于良性病变组(P<0.001);RI无显著性差异(P>0.05);T/N1组与T/N2组摄取比值无显著性差异(P>0.05).以甲状腺癌组摄取比值的(±s)为判断阈值,99mTc-MIBI显像对甲状腺癌诊断的灵敏度为75.00%-100.00%,特异性为81.25%-93.75%,准确性为84.09%-93.18%.T/N1组与T/N2组定量分析的灵敏度、特异性与准确性无显著性差异(P>0.05).结论:99mTc-MIBI显像对甲状腺单发结节良恶性鉴别诊断有较大的临床应用价值.     

63例甲状腺癌临床诊断及核素显像与病理对照分析

６３例甲状腺癌临床诊断及核素显像与病理对照分析严世平石民生王铁自１９８５～１９９５年期间朝阳医院共收治甲状腺疾病１４９８例，其中甲状腺癌（以下简称甲癌）６３例，占４．２％。我们就甲癌在结节疾病分布情况、甲癌在各类结节中的发病情况、甲癌与甲状腺结节数目...     

超声与超声联合核素显像诊断甲状腺结节的对比研究

目的：评价超声显像和超声联合核素显像对甲状腺结节良恶性的诊断价值和意义。方法：将110例手术切除的甲状腺结节患的超声诊断和超声联合核素显像诊断与病理诊断结果进行回顾性分析。结果：单纯超声诊断甲状腺结节的符合率为87．3％, 超声联核素显像的诊断符合率为90．9％,无论对良性结节或恶性结节,单纯超声诊断与超声联合核素显像诊断相比,两差异无显性（P＞0．05）。结论：对甲状腺结节的良恶性判断,超声联合核素显像与单纯超声诊断相比,并不能明显提高诊断符合率,超声检查仍应作为首选筛检方法。     

104例甲状腺癌核素显像与超声表现对比研究

目的探讨核素显像和超声表现对甲状腺癌的诊断价值。方法回顾性分析接受手术治疗的104例甲状腺癌患者的核素显像及超声与病理学资料，并进行对比研究。结果癌性肿块中核素显像示结节性病变者占90．4％（94／104），其中单发结节84．0％（79／94），多发结节16．0％（15／94），提示甲状腺癌核素显像中以单发结节多见（P〈0．001）。超声检查异常显示率99．0％（103／104），核素显像异常显示率82．7％（86／104），两者差异有显著性（P〈0．05），但在诊断甲状腺癌符合率上核索显像法为69．2％，超声法为68．3％，二者无明显差异（P〉0．05），联合检查对甲状腺癌诊断符合率明显优于单一检查（P〈0．05）。结论核素显像和超声检查各有优势，联合检查互相弥补不足，可明显提高异常显示率和诊断甲状腺癌符合率，但存在一定的误诊和漏诊，应引起足够重视。     

99mTc-MIBI显像对甲状腺结节良恶性的鉴别诊断价值

目的评价99mTc-MIBI(甲氧异腈)显像对鉴别甲状腺结节良恶性的临床价值.方法对122例99mTcO-4显像为结节的患者行99mTc-MIBI动态血流灌注、早期20分钟及延迟2小时静态平面显像.结果99mTc-MIBI动态血流灌注显像诊断甲状腺癌的灵敏度为53.8%(21/39),特异性为75.9%(63/83);早期20分钟静态平面显像诊断甲状腺癌的灵敏度为92.3%(36/39),特异性为60.24%(50/83);延迟2小时静态平面显像诊断甲状腺癌的灵敏度为87.2%(34/39),特异性为85.54%(71/83).5例患者颈部肿大的淋巴结摄取99mTc-MIBI.结论99mTc-MIBI显像对甲状腺结节良恶性的鉴别诊断具有较高的灵敏度和特异性,同时对甲状腺癌转移灶的诊断也有重要价值.     

99m^Tc-MIBI显像对甲状腺单发结节的诊断价值

目的：探讨99m^Tc-MIBI显像对甲状腺单发结节鉴别诊断的临床价值。方法：对甲状腺99m^TcO4-核素显像为单个＂冷结节＂的患者进行99m^Tc-MIBI显像,采集15min、30min及2h三时相的静态图像,将显像结果进行定量分析并与病理结果比较。结果：甲状腺癌组三时相的99m^Tc-MIBI摄取比值皆高于良性病变组（P〈0.001）;RI无显著性差异（P〉0.05）;T/N1组与T/N2组摄取比值无显著性差异（P〉0.05）。以甲状腺癌组摄取比值的（-x±s）为判断阈值,99m^Tc-MIBI显像对甲状腺癌诊断的灵敏度为75.00%-100.00%,特异性为81.25%-93.75%,准确性为84.09%-93.18%。T/N1组与T/N2组定量分析的灵敏度、特异性与准确性无显著性差异（P〉0.05）。结论：99m^Tc-MIBI显像对甲状腺单发结节良恶性鉴别诊断有较大的临床应用价值。     

不同大小甲状腺髓样癌与甲状腺乳头状癌的超声特征比较

目的探讨不同大小甲状腺髓样癌(MTC)的超声特征, 为不同大小MTC和甲状腺乳头状癌(PTC)的鉴别诊断提供有效信息。方法 2018年6月至2022年3月在天津医科大学肿瘤医院超声检查发现并经病理证实的MTC患者87例, PTC患者220例。以甲状腺结节最大径1 cm为界值, 将患者分为小结节组(最大径≤1 cm)和大结节组(最大径>1 cm)。小结节组97例, 其中MTC 28例, PTC 69例。大结节组210例, 其中MTC 59例, PTC 151例。按甲状腺结节分层后, 比较MTC与PTC患者甲状腺结节和转移性淋巴结的超声声像图特征、术前血清降钙素(CT)和癌胚抗原(CEA)水平。结果在小结节组中, MTC表现为低回声、边缘光滑、有血流信号的比例高于PTC, 差异有统计学意义(均P<0.05)。在大结节组中, MTC表现为囊实性、低回声、边缘光滑、有血流、血管分布为Ⅳ型的比例高于PTC, 并且MTC与PTC的钙化类型差异也有统计学意义(均P<0.05)。而无论结节大小, MTC与PTC的病灶数量、纵横比差异均无统计学意义(均P>0.05)。在小结节组中...     

超声造影判定甲状腺“温结节”的性质

目的：探讨应用超声造影鉴别诊断放射性核素显像表现为“温结节”的甲状腺结节的良恶性的价值.方法：回顾性分析97例ECT表现为“温结节”病变的超声造影表现,判定结节良恶性,并与病理结果相对照.结果：97例甲状腺结节中,13例超声造影表现为不均匀低增强,诊断为恶性;84例表现为均匀等/高增强或低增强,诊断为良性.超声造影诊断甲状腺恶性结节的灵敏度为91.67％,特异度97.65％,准确率96.91％.结论：超声造影可用以鉴别诊断放射性核素显像表现为“温结节”的甲状腺结节的良恶性.     

超微血管显像、彩色多普勒血流显像在甲状腺癌与甲状腺良性肿块鉴别诊断中的应用对比

目的 对比超微血管显像(SMI)、彩色多普勒血流显像(CDFI)在甲状腺癌与甲状腺良性肿块鉴别诊断中的价值.方法 对200例甲状腺结节患者分别在SMI与CDFI模式下进行诊断并行病理检查,以病理检查结果为金标准,比较SMI与CDFI模式诊断甲状腺癌与甲状腺良性肿块的灵敏度、特异度、准确度、阳性预测值、阴性预测值,以及SMI、CDFI模式下甲状腺癌与甲状腺良性肿块的血流分级.结果 病理检查结果显示,200例甲状腺结节患者中,87例诊断为甲状腺癌,113例诊断为甲状腺良性肿块.SMI诊断甲状腺癌的灵敏度为93.10％,特异度为91.15％,准确度为92.00％,阳性预测值为89.01％,阴性预测值为94.50％;CDFI诊断甲状腺癌的灵敏度为79.31％,特异度为70.80％,准确度为74.50％,阳性预测值为67.65％,阴性预测值为81.63％.SMI模式下甲状腺癌与甲状腺良性肿块血流检出率均高于CDFI模式(P﹤0.05).结论 SMI鉴别诊断甲状腺癌与甲状腺良性肿块的能力优于CDFI,具有较高的应用价值.     

Telomerase activity in "suspicious" thyroid cytology

BACKGROUND: Telomerase activity (TA) has been detected in most malignant neoplasms, including thyroid carcinomas. The authors studied the utility of TA detection as an ancillary tool to thyroid fine-needle aspiration (FNA) for patients with nonconclusive cytologic diagnoses. METHODS: Material obtained by FNA from palpable thyroid nodules in 167 consecutive patients was processed for conventional cytologic studies and simultaneously for TA study. Another 8 patients were excluded from TA because of the presence of lymphocytes. All patients with negative results cases were followed for > 1 year, and those who had tumors that were suspicious or positive by FNA or TA underwent resection for pathologic study of nodules. TA was analyzed by telomere repeat amplification protocol-polymerase chain reaction analysis. RESULTS: After excluding 20 patients because of insufficient material for cytologic study, 120 patients had negative results for malignant cells in cytology material, and the remaining 27 patients had results that were either suspicious (n = 21 patients) or positive (n = 6 patients). Histopathologic confirmation was obtained in 23 patients, including 18 with suspicious cytology (1 with scanty material) and 5 with positive FNA. The histopathologic diagnoses were nodular hyperplasia in 5 patients, follicular adenoma in 3 patients, papillary carcinoma in 11 patients, follicular carcinoma in 1 patient, medullary carcinoma in 2 patients, and lymphoma in 1 patient. TA was detected in 6 of 18 histologically confirmed thyroid neoplasms (1 of 3 follicular adenomas, 3 of 11 papillary carcinomas, 0 of 1 follicular carcinoma, 1 of 2 medullary carcinomas, and 1 of 1 lymphoma), including 1 neoplasm with scanty atypical cells. CONCLUSIONS: The detection of TA helped to confirm neoplasia in 6 of 23 suspicious thyroid nodules. Although it was less sensitive than FNA, TA specificity was 100% for neoplasia and 87.5% for malignancy. The sensitivity of thyroid FNA increased with the use of TA detection when cytology was nonconclusive for malignancy.     

Fine-needle aspiration cytodiagnosis of the "cold" thyroid nodule

The results of 1886 fine-needle cytoaspirations of solid, palpable thyroid nodules, "cold" on scintiscanning, performed between 1 January 1978 and 31 December 1986, were analyzed. In total 36 diagnoses of malignancy were made (1.9%). The results of cytologic and histologic examinations were compared in 114 cases to verify the diagnostic accuracy of this method; there was agreement in 98 cases and discordance in 16 consisting of 13 false negatives (11.4%) and 3 false positives (2.6%). The sensitivity was 77.9%, specificity 94.5%, positive predictive value 93.8%, negative predictive value 80% and test efficiency 86%. These values are in the range of those reported in the literature and confirm the validity of fine-needle aspiration cytology in the preoperative diagnosis of thyroid neoplasms.     

In search of a real "targeted" therapy for thyroid cancer

Over the past 5 years, patients with progressive radioactive iodine-refractory thyroid cancer have responded to "targeted" multikinase inhibitors, which inhibit angiogenesis and not the tumor cell. Here, selumetinib targets the mitogen-activated protein kinase pathway in papillary thyroid carcinoma and shows limited single-agent activity in the patients with tumors that harbor the (V600E)BRAF mutation.     

Experience with standardized thyroid fine-needle aspiration reporting categories: follow-up data from 529 cases with "indeterminate" or "atypical" reports

BACKGROUND.

A significant number of thyroid fine‐needle aspiration cytology (FNAC) cases yield inconclusive results. The recent National Cancer Institute guidelines and those published by other societies are important contributions to standardizing the diagnostic approach. Nevertheless, there are significant issues in the application of guidelines and the evaluation of their clinical efficacy. Data from individual departments can be useful in demonstrating the role of standardized reporting.

METHODS.

The authors followed 529 consecutive cases with inconclusive thyroid FNA results that were analyzed in a single laboratory in Western Australia. In that laboratory, standardized reporting in categories has been in place for a decade, and inconclusive cases have been subdivided into indeterminate and atypical groups. Follow‐up data was obtained for 341 indeterminate cases (17.2% of total thyroid FNA accessions) and for 188 atypical cases (9.5% of accessions).

RESULTS.

In total, 127 nodules with atypical results (67.6%) underwent surgical excision compared with 131 nodules with indeterminate results (38.4%; P < .0001). In 96 excised nodules with atypical results (75.6%), the excised specimens were identified as neoplastic compared with 61 excised nodules with indeterminate results (46.6%; P < .0001). In addition, 31 excised nodules with atypical results (24.4%) had a malignancy proven compared with 17 excised nodules with indeterminate results (13%; P < .05). In addition, 51 of 82 repeat FNAs (62.2%) among patients who had indeterminate results yielded a more specific diagnosis compared with 2 of 9 repeat FNAs (22.2%) among patients who had atypical results (P < .05).

CONCLUSIONS.

The routine subcategorization of patients who had inconclusive thyroid FNA reports into indeterminate and atypical groups resulted in statistically significant differences in the likelihood of neoplasia and malignancy. Patients who had indeterminate results were more likely to benefit from repeat FNAC than patients who had atypical results. The current results indicated that patients who fall into these 2 categories are likely to benefit from different clinical management protocols. Cancer Cancer Cytopathol 2010. © 2010 American Cancer Society.