评估甲状腺髓样癌患者淋巴结转移的三种方法的对比

Comparison of three methods for detecting metastatic lymphonodus in patients with medullary thyroid carcinoma

目的 评价淋巴结细针抽吸洗脱液中降钙素测定(FNAB+CT)与细针穿刺细胞学(FNAC)病理以及二者联合应用在评估甲状腺髓样癌(MTC)淋巴结转移中的诊断价值。方法 纳入滨医附院甲状腺外科自2021年以来诊治的16位MTC患者共计21枚淋巴结,行FNAB+CT和FNAC病理诊断,与术后组织学病理对照,对比FNAC、FNAB+CT、FNAC联合FNAB+CT三种诊断方法的诊断能力。结果 FNAC的敏感性、特异性、准确性、阳性预测值(PPV)和阴性预测值(NPV)分别为66.7%、91.7%、71.4%、71.4%和71.4%;FNAB+CT的敏感性、特异性、准确性、PPV和NPV分别为88.9%、91.7%、81%、88.9%和91.7%。FNAB+CT的诊断敏感性、准确性和NPV均显著高于FNAC,P<0.01或<0.05。此外,FNAC联合FNAB+CT,与单纯的FNAB+CT相比,其敏感性、准确性和NPV均显著提高。结论 FNAB+CT是甲状腺髓样癌淋巴结转移的早期可用诊断工具。FNAC联合FNAB+CT在转移淋巴结的检出方面比两者任何其一单独检测具有更好的诊断能力。

Objective To evaluate the diagnostic value of FNAB+CT alone or combined with cytology for detecting metastatic lymphonodus(LNs) in patients with medullary thyroid carcinoma(MTC).Methods Twenty-one LNs from 16 patients with MTC underwent sonographic guided fine-needle aspiration cytology and FNAB+CT, and the final diagnosis was confirmed by surgical pathology examination. The diagnostic performances of FNAC, FNAB+CT alone and of the combination of FNAC and FNAB+CT were compared.Results The sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of FNAC were 66.7%, 91.7%, 71.4%, 71.4%, and 71.4%, respectively, and the sensitivity, specificity, accuracy, PPV and NPV of FNAB+CT were 88.9%, 91.7%,81%, 88.9%, and 91.7%, respectively. The diagnostic sensitivity, accuracy and NPV of FNAB+CT was significantly higher than that of FNAC(P<0.01, P<0.05, and P<0.01, respectively). Furthermore, the combination of FNAC and FNAB+CT significantly increased sensitivity, accuracy and NPV as compared with FNAB+CT alone.Conclusion The FNAB+CT is a feasible diagnostic tool for the early detection of LNs metastases of MTC. The combination of FNAC and FNAB+CT yield better diagnostic performance in the detection of metastatic LNs than either one alone.