The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size
The incidence of cancer and rate of false-negative cytology in thyroid nodules greater than or equal to 4 cm in size
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DOI：
10.1016/j.surg.2007.08.012
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发表时间：
2007-12-01
期刊：
影响因子：
3.8
通讯作者：
Yim, John H.
中科院分区：
文献类型：
--
作者：
McCoy, Kelly L.;Jabbour, Noel;Yim, John H.
背景对于大于3 cm的甲状腺结节，细针穿刺活检（FNAB）的高假阴性率促使人们建议进行诊断性肺叶切除术。我们认为存在一个大于4厘米的结节是甲状腺切除术的一个独立的适应症，无论FNAB结果如何。我们回顾了2003年7月至2006年11月223例甲状腺结节大于或等于4 cm手术患者的临床资料。单灶性微乳头状癌被认为临床意义不大。临床上显著的甲状腺癌是常见的，发生在223例患者中的57例（26%）。亚组分析显示，223例患者中有43例（19.3%）在肿块内有癌，7例（3.1%）在切除的甲状腺其他部位有明显的癌。223例患者中有7例（3.1%）发现多灶性微乳头状癌。71例癌症患者中有9例（13%）（16%包括多灶性微乳头状癌）术前FNAB被错误地解读为良性。良性FNAB结果未能识别24例（34%）滤泡病变（包括7例癌症）。在术前FNAB结果分类为不确定病变的患者中，43例患者中有17例（40%）在最终病理检查中有肿块癌。甲状腺结节大于或等于4cm时，癌的发生率高，术前良性细胞学检查的假阴性率高。无论FNAB结果如何，大于或等于4 cm的甲状腺结节应考虑进行诊断性肺叶切除术。
Background. High false-negative rates for fine needle aspiration biopsy (FNAB) of thyroid nodules greater than 3 cm have prompted recommendations for diagnostic lobectomy. We considered the presence of a greater than 4 cm nodule an independent indication for thyroidectomy regardless of FNAB results.Methods. We reviewed clinical data from 223 patients with thyroid nodules greater than, or equal to 4 cm operated on from July 2003 to November 2006. Unifocal micropapillary cancer was considered clinically insignificant.Results. Clinically significant thyroid cancer was frequent, occurring in 57 of 223 patients (26%). Subgroup analysis showed that 43 of 223 patients (19.3 %) had carcinoma within the mass and that 7 of 223 patients (3.1 %) had significant carcinoma elsewhere in the resected thyroid. Multifocal micropapillary cancer was found in an additional 7 of 223 patients (3.1 %). Preoperative FNAB was read incorrectly as benign in 9 of 71 patients with cancer (13 %) (16 % including multifocal micropapillary carcinoma). Benign FNAB results failed to identify 24 (34 %) follicular lesions (including 7 cancers). In patients with preoperative FNAB results categorized as indeterminate lesions, 17 of 43 patients (40 %) had carcinoma of the mass on final pathology.Conclusions. In thyroid nodules greater than or equal to 4 cm, the incidence of carcinoma is high with a high false-negative rate for preoperative benign cytology. Thyroid nodules greater than or equal to 4 cm, should be considered for diagnostic lobectomy regardless of FNAB results.