摘要
目的 分析99 Tcm-甲氧基异丁基异腈（MIBI）亲肿瘤显像诊断甲状腺良、恶性结节出现假阳性和假阴性的影像和病理特征.方法 回顾性分析保定市第一中心医院核医学2015年1月-2017年1月因甲状腺结节行99 Tcm-MIBI亲肿瘤显像的患者临床病理资料,筛选出有确定性病理诊断的93例病例,采用目测法进行图像分析,判读标准分为亲肿瘤显像阳性、可疑阳性及阴性,所有数据与病理结果对比,计算99 Tcm-MIBI亲肿瘤显像的诊断效能,并分析出现假阳性和假阴性病例的临床病理特征.结果 以99 Tcm-MIBI亲肿瘤显像阳性/可疑阳性为诊断恶性病变的标准,诊断敏感性、特异性、准确性、阳性预测值及阴性预测值分别为87.50％ （21/24）、53.62％（37/69）、62.37％ （58/93）、39.62％ （21/53）和92.50％ （37/40）.良、恶性判断的假阳性和假阴性总发生率为37.63％（35/93）,甲状腺良性结节99 Tcm-MIBI显像真阴性组和假阳性组的临床参数分析显示,两组间性别、甲状腺球蛋白（Tg）、甲状腺球蛋白抗体（TgAb）及甲状腺过氧化物酶抗体（TPOAb）水平差异均无统计学意义,而年龄、结节直径及病理类型差异均有统计学意义（t=3.345,P=0.001;t=2.298,P=0.025;x2 =39.521,P=0.000）.假阳性的结节病理类型包括结节性甲状腺肿（29/32）、桥本甲状腺炎（2/32）、滤泡状腺瘤（1/32）,假阴性的结节病理类型均为甲状腺微小乳头状癌（3/3）,结节直径均≤1.0 cm.结论 99 Tcm-MIBI亲肿瘤显像诊断甲状腺结节良、恶性的阴性预测值很高,对于本研究中直径大于＞1.0 cm的结节,阴性预测值达100％.假阳性多出现在年龄大、结节直径大者,结节性甲状腺肿MIBI亲肿瘤显像易出现假阳性.
Objective To analyze the radiological and pathological features of false positive and false negative diagnosis in thyroid nodules with 99Tcm-MIBI scintigraphy.Methods The clinical and pathologic data of patients who had received 99Tcm-MIBI imaging for thyroid nodules from January,2015 to January,2017 in the Department of Nuclear Medicine in Baoding No.1 Central Hospital were retrospectively analyzed,and 93 cases out of these patients were diagnosed by pathological examination.Visual observation was used for image analysis,and the criterion of interpretation was divided into positive,suspicious positive and negative,and all data were compared with pathological results.The diagnostic efficacy of 99Tcm-MIBI imaging was calculated and the clinical pathological features of false positive and false negative cases were analyzed.Results According to the 99Tcm-MIBI tumour scintigraphy positive/suspicious positive standards,the diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value were 87.50％ （21/24）,53.62％ （37/69）,62.37％ （58/93）,39.62％ （21/53） and 92.50％ （37/40）,respectively.The total incidence of false positive and false negative was 37.63 ％ （35/93）.The clinical parameters analysis of 99Tcm-MIBI imaging in benign thyroid nodules between true negative group and false positive group showed that the differences of gender,thyroglobulin （Tg）,thyroglobulin antibody （TgAb） and thyroid peroxidase antibody （TPOAb） levels were not statistically significant,and the differences of age,diameter of nodule and pathological type were statistically significant （t =3.345,P =0.001;t =2.298,P =0.025;x2 =39.521,P =0.000） between two groups.The pathological types of pseudopositive nodular were nodular goiter （29/32）,Hashimoto＇ s thyroiditis （2/32）,and follicular adenoma （1/32）.All false negative nodules were thyroid papillary microcarcinoma （3/3）,and the diameters of all nodular were less than 1.0 cm.Conclusions The negative predictive value of 99Tcm-MIBI scintigraphy in diagnosing benign and malignant thyroid nodules is very high,and the negative predictive value is 100％ for the diameter of nodules larger than 1.0 cm in this study.False positive results are more likely to occur in older patients and patients with larger nodules.Nodular goiter is more likely to produce false positive results in 99Tcm-MIBI scintigraphy.
作者
张建阳
席永昌
尤立强
张力丹
张建媛
宋会民
Zhang Jianyang;Xi Yongchang;You Liqiang;Zhang Lidan;Zhang Jianyuan;Song Huimin(Department of Nuclear Medicine,Baoding No.1 Central Hospital,Baoding 071000,China)
出处
《国际内分泌代谢杂志》
2018年第5期298-301,共4页
International Journal of Endocrinology and Metabolism
