结合显像和细胞学检查是否有可能消除不适当甲状腺手术的数量?

S. Divani
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摘要

目的:虽然细针穿刺细胞学检查(FNAC)是临床上治疗异常甲状腺结节最可靠、安全、准确的方法,但仍有5%-15%的病例诊断不明确,因其可能是恶性的,建议手术治疗。然而,大多数细胞学不确定的病例是良性的,因此不必要的手术风险很大。在我们的研究中,我们将FNAC和闪烁成像相结合,以减少不适当手术的数量。对象和方法:219例甲状腺细针穿刺细胞学检查患者33例(男9例,女24例),年龄18-73岁,FNAC诊断不明确,转行显像检查。所有病例均行手术治疗。收集FNAC、荧光成像和组织学结果进行比较。结果:在33例细胞学不确定的病例中,32例组织学诊断为良性,只有1例为恶性(滤泡性Ca)。那个病例的扫描结果呈阳性。所有甲状腺扫描阴性的病例(29/33)均为良性。假阳性3例,真阳性1例,最终诊断为滤泡性癌。结论:本研究表明,在细胞学不确定的甲状腺结节中,FNAC与甲状腺显像相结合,可以将不适当的手术数量从32例减少到3例。
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Is it possible to eliminate the number of inappropriate thyroid surgeries combining scintigraphy and cytology?
Objective: Although fine needle aspiration cytology (FNAC) is the most reliable, safe and accurate method for the clinical management of abnormal thyroid nodules, 5%-15% of cases lead to indeterminate diagnoses and surgery is the recommended practice for them as they may be malignant. Nevertheless, the majority of cases with indeterminate cytology are benign, so the risk of unnecessary surgery is significant. In our study we combined FNAC and scintigraphy in order to reduce the number of inappropriate surgeries. Subjects and Methods: From 219 patients with thyroid fine needle aspiration cytology 33(9 males and 24 females) aged 18-73 years, had indeterminate FNAC diagnoses and were referred for scintigraphy. Surgery was performed in all cases. The results of FNAC, scintigraphy and histology were collected and compared. Results: From 33 cases with indeterminate cytology 32 had a benign histological diagnosis and only one was malignant (follicular Ca). That case had a positive scan. All cases with negative thyroid scans (29/33) were benign. False positive scans were 3, whereas one scan was true positive with final diagnosis follicular carcinoma. Conclusion: This study showed that combining the FNAC with the thyroid scintigraphy in cases of thyroid nodules with indeterminate cytology it is possible to reduce the number of inappropriate surgeries from 32 to 3.
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