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分子诊断和FDG-PET/CT在不确定的甲状腺结节中:补充技术还是浪费宝贵资源?

Elizabeth J de Koster^1,2, Hans Morreau³, Gysele S Bleumink⁴

¹Department of Medical Imaging and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.

Thyroid : official journal of the American Thyroid Association

|November 27, 2023

概括

分子诊断 (MD) 和2-[18F]-2-脱氧-d-葡萄糖 (18F]FDG) -positron发射断层扫描/计算机断层扫描 (PET/CT) 准确地排除了不确定的甲状腺结节中的恶性病变. 联合使用提供了有限的好处,这表明顺序测试是优先考虑的瘤安全管理.

科学领域:

内分泌学在内分泌学.
在瘤学瘤学.
核医学就是核医学.

背景情况:

准确的手术前评估不确定的甲状腺结节 (ITN) 对于避免不必要的诊断手术至关重要.
分子诊断 (MD) 和[18F]FDG-PET/CT是ITN评估的新兴工具.
了解它们的性能和相互作用是优化患者管理的关键.

研究的目的:

在ITN中评估MD和[18F]FDG-PET/CT的诊断性能.
评估两种模式的综合效用.
探索分子变化和[18F]FDG在良性结节中的吸收之间的关系.

主要方法:

对患有贝塞斯达III或IV甲状腺结节的成年患者进行前性多中心研究.
患者接受了MD (下一代测序) 和[18F]FDG-PET/CT.
计算了包括灵敏度,特异性,NPV,PPV和良性呼叫率 (BCR) 在内的绩效指标.

主要成果:

在87%的患者中,MD产生了诊断结果. MD显示80%的灵敏度和69%的特异性; [18F]FDG-PET/CT显示93%的灵敏度和41%的特异性.
组合测试产生了95%的灵敏度和44%的特异性,用于双阴性结果.
MD和[18F]FDG-PET/CT之间的一致性为63%;在[18F]FDG阳性良性结节中,MD阳性率更高.

结论:

MD和[18F]FDG-PET/CT都是ITN的有效排除测试,其性能因当地因素而异.
联合使用提供了边际的好处;顺序测试可能更合适.
在瘤细胞ITN中,MD优越,而在阴性MD后,可以考虑对非瘤细胞ITN进行连续测试.

关键词:

[18F]FDG-PET/CT/CT/FDG-PET/CT/CT/FDG-PET/PET/CT/CT/CT/FDG-PET/FDG-PET/CT/CT/CT/PET/CT/CT/FDG-PET/CT/CT 不确定的细胞学.分子诊断分子诊断分子诊断甲状腺癌是甲状腺癌.甲状腺结节甲状腺结节

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