Should all patients with thyroid nodules ≥ 1 cm undergo fine-needle aspiration biopsy?
Should all patients with thyroid nodules ≥ 1 cm undergo fine-needle aspiration biopsy?
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DOI：
10.3413/nukmed-0313
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发表时间：
2009-01-01
影响因子：
1.5
通讯作者：
Dietlein, M.
中科院分区：
文献类型：
--
作者：
Schicha, H.;Hellmich, M.;Dietlein, M.
在以前缺碘的地区，甲状腺结节>= 1 cm的患病率很高。假设所有患者均行细针穿刺活检（FNAB），且细胞学检查的敏感性和特异性均为85%，根据贝叶斯定理，病理细胞学检查的阳性预测值仅为1.5%。这在临床上是不可接受的，因为切除将是所有可疑细胞学病例的结果。即使进行第二次独立的检测（如甲状腺细胞的分子遗传学检测，检测突变的灵敏度为50%，特异性为95%）和应用序贯贝叶斯定理，联合病理结果的阳性预测值也仅增加到13%。然而，58%的甲状腺癌仍然没有被这种顺序算法检测到。因此，需要预先选择甲状腺结节进行FNAB，以将预检测概率提高到至少5- 10%。即使在TSH水平正常的患者中，超声标准和甲状腺造影的组合也适用于选择的甲状腺结节进行FNAB。
The prevalence of thyroid nodules >= 1 cm is high in a previously iodine-deficient area. Under the hypothesis, that all patients with such nodules undergo fine-needle aspiration biopsy (FNAB) and that sensitivity and specificity of cytology are calculated with 85%, the positive predictive value of pathologic cytologic finding will reach 1.5% only according to Bayes-theorem. This is clinically unacceptable, as resection will be the consequence in all cases with suspect cytology. Even implementation of a second, independent test (e.g. moleculargenetic testing of thyreocytes, sensitivity to detect mutation 50%, specificity 95%) and application of sequential Bayes-theorem the positive predictive value of combined pathologic findings will increase to 13% only. Nevertheless, 58% out of all thyroid cancer remain undetected by such a sequential algorithm.As a consequence, pre-selection of thyroid nodules for FNAB is required to increase the pretest-probability to at least 5-10%. A combination of sonographic criteria and scintigraphy, even in patients with normal TSH-levels, is suited to selected thyroid nodules for FNAB.