Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules
Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fine-needle aspiration of thyroid nodules
复制标题
DOI：
10.1097/00000658-200205000-00007
复制
发表时间：
2002-05-01
影响因子：
9
通讯作者：
Johnson, JE
中科院分区：
文献类型：
--
作者：
Goldstein, RE;Netterville, JL;Johnson, JE
目的分析甲状腺穿刺细胞学诊断的不典型和可疑的亚类，并将其与最后的组织学诊断相关联。背景资料甲状腺结节的细针穿刺（FNA）已成为甲状腺结节初步评估的主要诊断工具。甲状腺结节的治疗是基于特定细胞学阅读与恶性概率相关的统计数据。两种特殊的细胞学读数使细胞病理学家和外科医生都感到沮丧，即滤泡性肿瘤和显示滤泡的细胞。在大多数报道的系列中，滤泡性肿瘤和显示滤泡性的细胞被包括在一个广泛的“可疑”类别中，报告的总体恶性率通常在20%和30%之间，然而，有兴趣确定这些可疑病变是否可以被亚分类，从而更准确地评估恶性肿瘤的风险。此外，最近有证据表明，滤泡癌的发病率可能会下降，在这个国家，可能会降低的概率，“滤泡性肿瘤”将被证明是一个滤泡cancer.Methods从1994年1月至2000年12月，709甲状腺FNAs进行了在一个单一的机构。那些被解释为可疑和随后的组织学报告进行了审查。从这一组中，定义了四个特定类别，细胞学与这些类别匹配的患者的临床记录构成了本研究的主题。这四种类型是无滤泡性肿瘤、滤泡性肿瘤伴滤泡性肿瘤、滤泡性肿瘤和可疑恶性肿瘤。此外，还对非诊断性细胞学病变进行了审查。只有病变的组织学随访被considered.Results 98抽吸被归类为滤泡性肿瘤无卵巢囊肿，滤泡性肿瘤卵巢囊肿，或卵巢囊肿单独。在74例无甲状腺滤泡性肿瘤中，只有5例（6.8%）为恶性，无一例为甲状腺滤泡性癌。9例病变为滤泡性肿瘤伴淋巴结转移，其中4例（44.4%）为恶性，包括2例浸润性滤泡癌。在仅显示甲状腺肿大的IS病变中，3例（20%）为恶性，均为甲状腺乳头状癌。另外25例患者的病变高度怀疑为恶性，其中21例（84%）为恶性，大多数为甲状腺乳头状癌，仅1例为滤泡癌。50例非诊断性细胞学检查的患者随后采取了措施。31这些病变切除，5（16.1%）被证明是malignant.Conclusions甲状腺结节的FNA被诊断为高度可疑的恶性肿瘤应切除，除非有显着的禁忌症的外科手术。在所有滤泡性肿瘤中浸润性滤泡癌的发生率极低（2%）可能反映了滤泡癌组织学标准的变化，疾病频率的真实变化，或两者兼而有之。对于细胞学检查显示为滤泡性肿瘤而不伴有结节的甲状腺结节，恶性率为8%或更低可能允许非手术治疗，包括在选定人群中进行重新评估。继续努力将恶性肿瘤发生率与特定的细胞学标准相关联，将使患者能够就其医疗护理做出更明智的决定。
Objective To break out subcategories of atypical and suspicious cytologic interpretations of thyroid aspirations and correlate those with final histologic diagnosis.Summary Background Data Fine-needle aspiration (FNA) of thyroid nodules has become the primary diagnostic tool in the initial evaluation of thyroid nodules, Management of thyroid nodules is based on statistical data correlating a specific cytologic reading with the probability of malignancy. Two particular cytologic readings that frustrate both cytopathologists and surgeons are follicular neoplasms and cells that show atypia. In most reported series, follicular neoplasms and cells showing atypia are included in a broad "suspicious" category, with reported overall malignancy rates generally between 20% and 30%, However, there is interest in determining whether these suspicious lesions can be subcategorized, allowing a more accurate assessment of the risk of malignancy. In addition, there is recent evidence that the incidence of follicular cancer may be declining in this country, possibly decreasing the probability that a "follicular neoplasm" will prove to be a follicular cancer.Methods From January 1994 through December 2000, 709 thyroid FNAs were performed at a single institution. Those interpreted as suspicious and the subsequent histologic reports were reviewed. From this set, four specific categories were defined, and the clinical records for patients whose cytology matched these categories form the subject of this study. These four categories are follicular neoplasms without atypia, follicular neoplasms with atypia, atypia, and suspicious for malignancy. In addition, lesions with nondiagnostic cytology were reviewed. Only lesions for which there was histologic follow-up were considered.Results Ninety-eight aspirates were categorized as follicular neoplasms without atypia, follicular neoplasms with atypia, or atypia alone. Of 74 follicular neoplasms without atypia, only 5 (6.8%) were malignant, and none of these were follicular thyroid cancers. Nine of the lesions were follicular neoplasms with atypia, and four (44.4%) of these were malignant, including two that were invasive follicular cancers. Of IS lesions showing atypia alone, 3 (20%) were malignant, all of which were papillary thyroid cancers. Twenty-five additional patients had lesions highly suspicious for malignancy, Twenty-one (84%) of these lesions were malignant, the majority being papillary thyroid cancers, Only one was a follicular cancer. Fifty patients with nondiagnostic cytology had subsequent action taken. Thirty-one of these lesions were resected, with five (16.1%) proving to be malignant.Conclusions Thyroid nodules whose FNA is diagnosed as highly suspicious for malignancy should be resected unless there are significant contraindications to a surgical procedure. The extremely low rate (2%) of invasive follicular cancers among all follicular neoplasms may reflect changing histologic criteria for follicular carcinoma, a true change in the disease frequency, or both. For thyroid nodules whose cytology shows a follicular neoplasm without atypia, malignancy rates of 8% or less may allow nonsurgical options, including reevaluation in selected populations. Continued efforts to correlate malignancy rates to specific cytologic criteria will allow patients to make more informed decisions regarding their medical care.