^131I—WBS、Tg和X线胸片诊断分化型甲状腺癌肺转移灶的比较研究

目的对131磺全身显像(131I-WBS)、Tg和X线胸片检测分化型甲癌肺转移灶的临床价值进行比较研究.62例被怀疑有甲癌肺转移患者,通过随访、术后剩余甲状腺被131碘去除前后血清甲状腺球蛋白(Tg)测定,诊断与治疗剂量131I-WBS和X光胸片三种检查.结果表明14例确诊阴性患者,三项检查均为阴性,因而特异性均为100%.48例阳性患者中,剩余甲状腺去除前诊断剂量131I-WBS敏感性69%,准确性76%,治疗剂量131I-WBS敏感性75%,准确性81%,Tg敏感性73%,准确性79%,X光胸片敏感性52%,准确性63%,明显低于Tg和131I-WBS(P＜0.05).将三种检查合并,其敏感性与准确性明显提高,分别达92%和94%.剩余甲状腺去除后131I-WBS(诊断与治疗剂量敏感性相同)敏感性和准确性分别达96%和97%,而Tg和X光胸片无变化.结果提示三种检查诊断肺转移灶都有较好的特异性,但敏感性以131I-WBS＞Tg＞X光胸片,尤其是剩余甲状腺被去除后;三种检查联合使用于高度怀疑肺转移的患者可提高检出率.

Comparative Study of 131I-WBS,HTg and Chest X-ray in Diagnosing Pulmonary Metastases in Patients with Differentiated Thyroid Carcinoma

The clinical value of HTg, 131I-WBS and Chest X-Ray in detecting pulmonary metastases of DTC was compared.62 patients who were suspected pulmonary metastases,received examinations of these three methods before and after ablation of residual thyroid.The results showed that 14 patients were free of pulmonary metastases according to the findings of HTg, 131I-WBS and Chest X-Ray and all the specificities of three methods were 100%.In 48 patients with confirmed pulmonary metastases,the sensitivity for diagnostic doses 131I-WBS,therapeutic doses 131I-WBS,HTg and chest X-ray was 69%,75%,73% and 52% respectively;the accuracy for diagnostic does 131I-WBS,therapeutic doses 131I-WBS,HTg and chest X-ray was 76%,81%,79% and 63% respectively before ablation of residual thyroid.The sensitivity and accuracy was significantly increased by combined resuls of three methods with a 92% of sensitivity and a 94% of accuracy.After ablation of residual thyroid,the sensitivity and accuracy of 131I-WBS was increased to 96% and 97% respectively,but the results of HTg and chest X-ray were same as before.The results indicate that there are good specificities for three methods in detecting pulmonary metastases,but the sensitivities are followed in this order: 131I-WBS>HTg>chest X-ray,especially after ablation of residual thyroid.The combined results of three methods would detect pulmonary metastases of DTC with a high yield.