Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules
Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules
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DOI：
10.1210/jc.2002-020865
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发表时间：
2002-11-01
影响因子：
5.8
通讯作者：
Marqusee, E
中科院分区：
文献类型：
--
作者：
Alexander, EK;Heering, JP;Marqusee, E
甲状腺结节很常见。对甲状腺结节患者的评估通常包括细针抽吸活检 (FNA)，这种方法已被证明可准确检测甲状腺癌。尽管大多数活检足以进行细胞学诊断，但高达 20% 的活检仍不充分或无法诊断。目前的观点建议应重复进行此类抽吸，尽管没有系统研究调查这种方法的有用性，特别是当使用超声引导来指导初始 FNA 时。我们试图确定初始非诊断性超声引导下甲状腺结节 FNA 的预测因素和最佳随访策略。收集了 1995 年至 2000 年间在布莱根妇女医院甲状腺结节诊所接受超声引导下甲状腺结节 FNA 的所有患者的数据。建议所有细胞学检查无法诊断的患者返回进行重复超声引导下的细针穿刺活检。患者年龄、性别、结节大小、囊性内容、孤立性甲状腺与多结节性甲状腺以及结节位置均被记录并评估为多变量模型中非诊断性活检的可能预测因素。计算了重复超声引导 FNA 获得的诊断细胞学率。在 6 年期间，总共对 1128 名患者的 1458 个结节进行了活检。总共 1269 次活检（950 名患者）具有诊断性，189 次活检（178 名患者）没有诊断性。每个结节的囊性内容物是非诊断性细胞学的唯一显着的独立预测因子（P < 0.001）。初始细胞学无法诊断的标本比例随着囊性内容物的增加而增加（趋势 P < 0.001）。 63% 的结节在第一次重复活检时获得了诊断性超声引导 FNA，并且与每个结节囊性内容的增加呈负相关 (P = 0.03)。 119 名患有 127 个结节的患者按照建议返回进行随访，其中 5% 记录有恶性肿瘤。尽管采用了超声引导下 FNA，但初始细胞学检查仍存在显着的非诊断性风险，这主要是通过每个结节的囊性内容物来预测的。考虑到其恶性风险，重复抽吸通常是成功的，应该成为此类结节的标准方法。
Thyroid nodules are common. Evaluation of patients with thyroid nodules typically includes fine needle aspiration biopsy (FNA), an approach that has proven to be accurate for the detection of thyroid cancer. Although the majority of biopsies are adequate for a cytological diagnosis, up to 20% will be insufficient or nondiagnostic. Current opinion suggests that such aspirates should be repeated, although no systematic study has investigated the usefulness of this approach, especially when ultrasound guidance is used to direct the initial FNA. We sought to define the predictors and optimal follow-up strategy for initial nondiagnostic ultrasound-guided FNAs of thyroid nodules.Data were collected for all patients at the Brigham and Women's Hospital Thyroid Nodule Clinic between 1995-2000 who underwent ultrasound-guided FNA of a thyroid nodule. All patients with nondiagnostic cytology were advised to return for a repeat ultrasound-guided FNA. Patient age, gender, nodule size, cystic content, solitary vs. multinodular thyroid, and nodule location were documented and evaluated as possible predictors of a nondiagnostic biopsy in a multivariable model. The rate of diagnostic cytology obtained on repeat ultrasound-guided FNA was calculated.A total of 1128 patients with 1458 nodules were biopsied over a 6-yr period. A total of 1269 aspirations (950 patients) were diagnostic, and 189 (178 patients) were nondiagnostic. The cystic content of each nodule was the only significant independent predictor of nondiagnostic cytology (P < 0.001). The fraction of specimens with initial nondiagnostic cytology increased with greater cystic content (P < 0.001 for trend). A diagnostic ultrasound-guided FNA was obtained on the first repeat biopsy in 63% of nodules and was inversely related to increasing cystic content of each nodule (P = 0.03). One hundred and nineteen patients with 127 nodules returned for follow-up as advised, and malignancy was documented in 5%.Despite ultrasound-guided FNA, there remains a significant risk of initial nondiagnostic cytology, largely predicted by the cystic content of each nodule, Repeat aspiration is often successful and should be the standard approach to such nodules, given their risk of malignancy.