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分化型甲状腺癌是最常见的甲状腺恶性肿瘤,占人体恶性肿瘤的0.2%~1.0%。据2020年全球癌症统计数据发布的内容显示,甲状腺癌发病率位居所有恶性肿瘤的第7位,在女性恶性肿瘤中位居第4位[1]。甲状腺癌的组织病理学分型分为:DTC、未分化型甲状腺癌及甲状腺髓样癌,其中超过90%的甲状腺癌为DTC。大部分DTC患者需要接受手术治疗+术后131I治疗+TSH抑制治疗[2]。
DTC患者经外科手术切除病灶后,可通过131I全身显像(包括诊断剂量和治疗剂量的131I全身显像)判断有无残留的甲状腺组织及功能性转移灶,从而诊断是否存在复发或转移,这对制定下一步治疗计划具有极其重要的临床意义。在131I全身显像中,甲状腺床区显影是由于术后存在残留的甲状腺组织,转移灶显影是由于转移灶具有同原发灶一样的摄碘功能。但是其他部位出现131I摄取的情况并不少见,其原因可能是生理性摄取及污染,如残留甲状腺组织、舌下腺、颌下腺、乳腺、食道以及体外污染等;也可见于病理性摄取及其他原因。因此,医师在临床工作中需详细了解和观察摄取的部位、形状、血清甲状腺球蛋白(thyroglobulin,Tg)水平、患者的病史和体征,并结合SPECT/CT、超声、CT等其他影像学资料进行有针对性的鉴别诊断[3]。在131I全身显像中,如果甲状腺床区及转移灶以外的部位或组织出现异常浓聚灶,临床上称此现象为131I全身显像假阳性。若不能对131I全身显像假阳性进行正确判读,可能会导致误诊,从而使患者接受不必要的131I治疗,这不仅会造成医疗资源的浪费,还会增加患者的医疗照射剂量。因此,我们从病因学的角度对131I全身显像假阳性的原因进行系统综述,旨在为临床医师正确解读图像、判断患者病情及制定合理的治疗方案提供理论依据。
从病因学角度分析分化型甲状腺癌患者131I全身显像假阳性的原因
Analysis of the causes of false positive 131I whole body imaging in patients with differentiated thyroid carcinoma from the perspective of etiology
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摘要: 131I全身显像可为分化型甲状腺癌(DTC)患者转移或复发的诊疗方案提供主要依据,是目前临床不可或缺的辅助诊疗方法。然而,由于多种生理或病理原因,可能会导致131I全身显像假阳性,这对正确解读131I全身显像、判断是否存在复发和转移造成了较大困难。因此,了解造成131I全身显像假阳性的原因对DTC患者的正确诊治具有非常重要的价值。笔者从病因学的角度对DTC患者131I全身显像假阳性的原因进行综述。Abstract: 131I whole body imaging can provide the main basis for the diagnosis and treatment of metastasis or recurrence of differentiated thyroid cancer (DTC). It is an indispensable method of clinical diagnosis and treatment at present. However, due to a variety of physiological or pathological reasons, 131I whole body imaging may be false positive, which makes it difficult to correctly interpret 131I whole body imaging and judge whether there is recurrence and metastasis. Therefore, it is of great value to be familiar with the causes of false positive 131I whole body imaging for the correct diagnosis and treatment of DTC patients. The authors reviewed the causes of false positive 131I whole body imaging in patients with DTC from the perspective of etiology.
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