Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules
Indications and limits of ultrasound-guided cytology in the management of nonpalpable thyroid nodules
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DOI：
10.1210/jc.84.1.24
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发表时间：
1999-01-01
影响因子：
5.8
通讯作者：
Aurengo, A
中科院分区：
文献类型：
--
作者：
Leenhardt, L;Hejblum, G;Aurengo, A
虽然超声(US)引导下的细针吸取活检(FNAB)被广泛用于不可触及的甲状腺结节，但本研究的目标是精确地确定一系列450个不可触及结节的US-FNAB的适应症和限度。在94例手术对照病例中，20例被诊断为癌(8例小于等于10厘米，12个大于等于等于厘米)。US-FNAB诊断恶性肿瘤16例，3例因细胞学资料不足而漏诊，1例误诊。US-FNAb的敏感性和特异性分别为94%和63%。Logistic模型表明，结节大小(P<；0.0003)与组织学诊断无关，但实性低回声特征更有可能是恶性的(P<；0.6)，US对恶性的敏感性和特异性分别为80%和70%。Logistic回归分析显示，随着结节大小的增加，细胞学材料的充分性显著增加(P<；0.0001)。这一结果概述了US-FNAB在小结节中的限度。因此，US-FNAB的指征在厘米或高回声结节或实性和低回声结节中似乎是明智的。这样的管理将允许发现20种癌症中的15种，并将避免16%的不必要的活组织检查。
Although ultrasound (US)-guided fine needle aspiration biopsy (FNAB) is widely prescribed in nonpalpable thyroid nodules, the goal of this study was to define precisely the indications and limits of US-FNAB in a series of 450 nonpalpable nodules. Among 94 surgically controlled cases, 20 (8 infracentimetric and 12 centimetric or supracentimetric) carcinomas were diagnosed. The diagnosis of malignancy was successfully made by US-FNAB in 16 of 20 carcinomas, 3 were missed because of insufficient cytological material, and 1 was misdiagnosed. US-FNAB sensitivity and specificity were 94% and 63%, respectively. A logistic model indicated that nodule size (P < 0.6) was not associated with histological diagnosis, but that solid hypoechoic features mere more likely to be malignant (P < 0.0003), with US sensitivity and specificity for malignancy of 80% and 70%, respectively. Logistic regression indicated that adequate cytological material significantly increased with nodule size (P < 0.0001). This result outlined the limits of US-FNAB in small nodules. Hence, indication of US-FNAB appears judicious in centimetric or supracentimetric nodules or in solid and hypoechoic ones. Such a management would allow the discovery of 15 of 20 carcinomas and would avoid 16% of unnecessary biopsies.