Papillary carcinoma of the thyroid: can operative management be based solely on fine-needle aspiration?
Papillary carcinoma of the thyroid: can operative management be based solely on fine-needle aspiration?
复制标题
甲状腺乳头状癌：能否仅依靠细针抽吸进行手术治疗？
DOI：
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发表时间：
1997
影响因子：
5.2
通讯作者：
R. Udelsman
中科院分区：
文献类型：
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作者：
Herbert Chen;M. Zeiger;Clark Dp;William H. Westra;R. Udelsman
背景
细针穿刺细胞学检查对于发现恶性肿瘤如甲状腺乳头状癌是敏感的。因为细针穿刺对甲状腺乳头状癌的特异性是可变的，常规的术中冰冻切片往往是提倡的。
研究设计
为了明确细针穿刺和冰冻切片在甲状腺乳头状癌中的作用，我们回顾了1989年8月至1995年8月间因甲状腺乳头状癌行甲状腺切除术的82例患者的资料。细针穿刺结果分为三类：甲状腺乳头状癌的诊断;甲状腺乳头状癌的滤泡变异的诊断;或甲状腺乳头状癌的可疑。在永久性组织学上做出了明确诊断。
结果
细针穿刺显示甲状腺乳头状癌对癌症的特异性为98%，对甲状腺乳头状癌的滤泡变体的特异性为100%。怀疑为甲状腺乳头状癌的细针穿刺（n = 24）对癌症的特异性仅为54%。根据术中大体所见，这24例患者中有5例接受了无冰冻切片的甲状腺全切除术，且均患有癌。其余19例进行了冰冻切片分析。在5例通过冷冻切片检测到癌症的患者中，4例在永久组织学上具有癌症。冷冻切片的结果显示，在其他14例患者的滤泡性肿瘤，其中4最终是癌症。
结论
当细针穿刺明确诊断为甲状腺乳头状癌或甲状腺乳头状癌的滤泡变体时，外科医生可以在没有冷冻切片的情况下进行明确的甲状腺切除术，因为癌症的特异性很高。如果细针穿刺怀疑为甲状腺乳头状癌，癌症的发生率为54%，患有这些疾病的患者应接受冷冻切片手术。当大体检查或冰冻切片提示恶性肿瘤时，可以进行明确的甲状腺切除术，因为90%的此类病例将是癌症。如果冰冻切片不能诊断为恶性肿瘤，建议进行甲状腺叶/峡部切除术，因为71%的患者有良性病变。这种系统性的甲状腺乳头状癌的方法将避免不必要的冷冻切片，同时保持良好的诊断特异性。
BACKGROUND
Fine-needle aspiration cytology is sensitive for detecting malignancies such as papillary carcinoma of the thyroid gland. Because fine-needle aspiration specificity for papillary carcinoma of the thyroid is variable, routine intraoperative frozen section is often advocated.
STUDY DESIGN
To define the roles of fine-needle aspiration and frozen section in papillary carcinoma of the thyroid gland, we reviewed data from 82 patients who underwent thyroidectomy between August 1989 and August 1995 for papillary carcinoma of the thyroid cytology. Results of fine-needle aspirations were grouped into three categories: diagnostic of papillary carcinoma of the thyroid; diagnostic of follicular-variant of papillary carcinoma of the thyroid; or suspicious for papillary carcinoma of the thyroid. Definitive diagnoses were made on permanent histology.
RESULTS
A fine-needle aspiration revealing papillary carcinoma of the thyroid was 98 percent specific for cancer or 100 percent specific for follicular-variant of papillary carcinoma of the thyroid. A fine-needle aspiration that was suspicious for papillary carcinoma of the thyroid (n = 24) was only 54 percent specific for cancer. On the basis of gross intraoperative findings, 5 of these 24 patients underwent total thyroidectomy without frozen section, and all had carcinoma. The other 19 had frozen section analysis. Of the 5 patients with cancer detected by frozen section, 4 had cancer on permanent histology. Findings on frozen section demonstrated a follicular neoplasm in the other 14 patients, of which 4 ultimately were cancer.
CONCLUSIONS
When papillary carcinoma of the thyroid or follicular-variant of papillary carcinoma of the thyroid is definitively diagnosed on fine-needle aspiration, the surgeon can perform definitive thyroidectomy without frozen section because of the high specificity for cancer. If the fine-needle aspiration is suspicious for papillary carcinoma of the thyroid, the incidence of cancer is 54 percent, and patients with these conditions should undergo surgery with frozen section. When either gross findings or frozen sections suggest malignancy, definitive thyroidectomy can be performed because 90 percent of such cases will be cancer. If frozen section is not diagnostic of malignancy, a thyroid lobectomy/isthmusectomy is recommended because 71 percent have a benign lesion. This systematic approach to papillary carcinoma of the thyroid will obviate unnecessary frozen sections while maintaining excellent diagnostic specificity.