核素显像在多发甲状腺结节FNAB筛查甲状腺癌中的增益价值

The Diagnostic Value of 99TcmO4^- Imaging in FNAB Screening for Thyroid Cancer in Multiple Thyroid Nodules

目的探讨高锝酸盐(99TcmO-4)核素显像对超声(US)引导下行细针穿刺活检(FNAB)诊断甲状腺结节良恶性的增益价值。方法选取2017年12月至2019年5月于桂林医学院附属医院就诊并同时行甲状腺核素显像及超声显像检查,提示有甲状腺结节患者105例共285个结节,对比超声和核素显像以及核素显像并标记选择后的超声引导下FNAB对诊断甲状腺结节良恶性的效能。结果(1)285个结节中经细针穿刺病理结果提示恶性结节47个,良性结节238个。(2)TI-RADS 3、4a、4b、4c、5类结节的超声诊断及联合显像诊断指导FNAB的灵敏度分别为(0%、14.7%)、(11.3%、17.6%)、(17.9%、24.0%)、(53.3%、53.6%)、(100%、100%),其中TI-RADS 3类结节两种检查方式指导FNAB的灵敏度的差异具有明显统计学意义(χ^2=16.216,P<0.001);TI-RADS 4类结节组内比较差异均无明显统计学意义(χ^2=1.976、1.085、0.020,P=0.160、0.298、0.887);TI-RADS 5类结节超声及联合检查无诊断效能差异。(3)TI-RADS 3类及4a类、4b类结节“冷”“凉”结节较“温”“热”及阴性结节FNAB的恶性结节的阳性率更高,差异具有显著统计学意义(χ^2=13.315、10.010、11.033,P<0.001、0.002、0.001);TI-RADS 4c类及5类“冷”“凉”结节对比“温”“热”结节及阴性结节FNAB的阳性率差异均无显著统计学意义。结论在甲状腺多发结节患者中,在单纯超声检查无法准确鉴别良恶性且无明显FNAB指征时,可以通过核素功能显像联合超声从功能和结构上对甲状腺结节进行多层次评估,对指导FNAB具有一定的增益价值。

Objective To investigate the value of 99TcmO-4 imaging in the diagnosis of thyroid nodules by US-guided fine-needle aspiration biopsy(FNAB).Methods A retrospective analysis was carried out on 105 nodules in 285 patients who received ultrasound and radionuclide imaging simultaneously from December,2017 to May,2019.The efficacies of contrast ultrasound and 99TcmO-4 imaging and labeled ultrasound-guided FNAB in the diagnosis of thyroid nodules were evaluated and compared.Results(1)The pathological results of 286 nodules by fine needle puncture indicated 47 malignant nodules and 239 benign nodules.(2)The sensitivities of ultrasonic diagnosis and combined imaging FNAB for the diagnosis of TI-RADS 3,4a,4b,4c,5 nodules were as following:0%,14.7%;11.3%,17.6%;17.9%,24.0%;53.3%,53.6%;and 100%,100%,in which the sensitivity of TI-RADS 3 for two types of inspection instruction FNAB had a significant difference(χ^2=16.216,P<0.001).There were no statistically significant differences among TI-RADS 4(χ^2=1.976,1.085,0.020,P=0.160,0.298,0.887).There was no difference in diagnostic efficacy between US and combined examination of TI-RADS 5.(3)The positive rates of“cold”and“cool”nodules in TI-RADS 3,4a,4b were significantly higher than those of“warm”and negative nodules in FNAB(χ^2=13.315,10.010,11.033,P<0.001,0.002,0.001).The positive rates of TI-RADS 4c and 5“cold”and“cool”nodules,compared with“warm”and“hot”nodules and negative nodule FNAB,were not statistically significant.Conclusion In patients with multiple thyroid nodules,when US cannot accurately distinguish benign from malignant and there is no obvious FNAB indication,multiple levels of thyroid nodules can be evaluated from the functional and structural aspects by 99TcmO-4 functional imaging combined with ultrasound,which has certain gain-value in guiding FNAB.