Merchant S H, Izquierdo R, Khurana K K
Department of Pathology, State University of New York, Syracuse 13210, USA.
Thyroid. 2000 Jun;10(6):489-92. doi: 10.1089/thy.2000.10.489.
Management of nonneoplastic thyroid nodules (TN) diagnosed by fine-needle aspiration (FNA) is controversial. While clinical follow-up with repeat FNA for enlarging TN is recommended in some studies, others recommend repeat FNA in follow-up of all benign TN after several months or years, in order to identify possible misdiagnosed malignant lesions. This study was done to determine the usefulness of repeat FNA in patients with benign nodular thyroid disease. We studied 94 fine-needle reaspirations performed on 43 females and 2 males 48.2 +/- 17 years of age with benign nodular thyroid nodular disease. Four patients had 3 consecutive FNAs and 41 patients had 2 consecutive FNAs. All FNAs were carried out by the same endocrinologist in the same thyroid area or by cytopathologists. The average time elapsed between the two consecutive FNAs was 18.3 +/- 11.2 (range, 4-48) months. Of the 45 patients, 23 presented with increase in size of the nodule and the remaining 22 patients did not have any change in size at the time of repeat FNA. Identical cytologic diagnoses were rendered in 39 of the 45 patients who underwent 2 or 3 consecutive FNA. Repeat FNA did not result in detection of any malignant neoplasms. Thyroid resection in 7 patients with increased nodule size and pressure symptoms confirmed the cytologic impressions of benign thyroid nodular disease. Our results show that the routine performance of repeated FNA cytology in the follow-up of patients with benign nodular thyroid disease with or without any clinical changes is of limited usefulness. Clinical factors rather than repeat FNA may hold precedence in surgical management of patients with benign nodular thyroid disease.
细针穿刺活检（FNA）诊断出的非肿瘤性甲状腺结节（TN）的管理存在争议。一些研究建议对增大的TN进行临床随访并重复FNA，而另一些研究则建议在数月或数年之后对所有良性TN进行随访时重复FNA，以便识别可能误诊的恶性病变。本研究旨在确定重复FNA对良性结节性甲状腺疾病患者的实用性。我们研究了对43名女性和2名男性（年龄48.2±17岁）进行的94次细针重复穿刺活检，这些患者患有良性结节性甲状腺疾病。4名患者连续进行了3次FNA，41名患者连续进行了2次FNA。所有FNA均由同一位内分泌科医生在同一甲状腺区域进行，或由细胞病理学家进行。两次连续FNA之间的平均时间间隔为18.3±11.2（范围4 - 48）个月。在这45名患者中，23名患者的结节大小增大，其余22名患者在重复FNA时结节大小没有任何变化。在接受2次或3次连续FNA的45名患者中，39名患者的细胞学诊断相同。重复FNA未检测到任何恶性肿瘤。对7名结节增大且有压迫症状的患者进行甲状腺切除，证实了良性甲状腺结节疾病的细胞学印象。我们的结果表明，对有或无任何临床变化的良性结节性甲状腺疾病患者进行随访时常规重复FNA细胞学检查的实用性有限。在良性结节性甲状腺疾病患者的手术管理中，临床因素而非重复FNA可能更为重要。
