Baloch Z W, Tam D, Langer J, Mandel S, LiVolsi V A, Gupta P K
Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
Diagn Cytopathol. 2000 Dec;23(6):425-9. doi: 10.1002/1097-0339(200012)23:6<425::aid-dc14>3.0.co;2-3.
Several studies have shown that ultrasound guidance can serve as a valuable aid in improving the diagnostic yield of fine-needle aspiration (FNA) biopsy of thyroid nodules. In this study, we evaluated the combined impact of ultrasound-guidance, rapid on-site evaluation of FNA specimens, and different cytologic preparations (fresh and alcohol-fixed smears, Millipore filter) and staining methods (Diff-Quik and Papanicolaou stains) on the diagnostic yield of thyroid FNA. Ultrasound-guided FNA was performed on 282 patients (313 cases) between November 1997 and April 1999. The diagnostic categories included: benign (198 cases, 63.2%); indeterminate (42 cases, 13.4%); suspicious for follicular variant of papillary carcinoma (26 cases, 8.3%), malignant (32 cases, 10.1%); and nondiagnostic (15 cases, 5%). The nondiagnostic cases also included 6 cystic lesions without any solid component and 3 thyroid-bed aspirations. After excluding these, the nondiagnostic rate was only 2%. Histological follow-up was available in 77 (77/313) cases. The concordance rate between cytological and histological diagnosis was 100% in malignant, 67% in suspicious, and 56% in indeterminate cases. All cases with histologic follow-up were selected to evaluate the independent diagnostic efficacy of each aforementioned cytologic staining method. A definite diagnosis could be made solely on the basis of air-dried, Diff-Quik-stained preparations in 50 (65%), alcohol-fixed, Papanicolaou stained smears in 68 (88%), and Millipore filter preparations in 70 (91%) cases. We conclude that ultrasound-guided FNA combined with on-site evaluation and different cytologic preparations can significantly improve the diagnostic accuracy of thyroid FNA specimens.
多项研究表明，超声引导有助于提高甲状腺结节细针穿刺抽吸活检（FNA）的诊断率。在本研究中，我们评估了超声引导、FNA标本的快速现场评估、不同的细胞学制片方法（新鲜涂片和酒精固定涂片、密理博滤膜）以及染色方法（Diff-Quik染色和巴氏染色）对甲状腺FNA诊断率的综合影响。1997年11月至1999年4月期间，对282例患者（313个病例）进行了超声引导下FNA。诊断类别包括：良性（198例，63.2%）；不确定（42例，13.4%）；可疑为乳头状癌滤泡变异型（26例，8.3%），恶性（32例，10.1%）；以及无法诊断（15例，5%）。无法诊断的病例还包括6个无任何实性成分的囊性病变和3次甲状腺床穿刺。排除这些病例后，无法诊断率仅为2%。77例（77/313）有组织学随访结果。恶性病例的细胞学和组织学诊断符合率为100%，可疑病例为67%，不确定病例为56%。选择所有有组织学随访的病例来评估上述每种细胞学染色方法的独立诊断效能。仅根据空气干燥、Diff-Quik染色制片可明确诊断的病例有50例（65%），酒精固定、巴氏染色涂片可明确诊断的病例有68例（88%），密理博滤膜制片可明确诊断的病例有70例（91%）。我们得出结论，超声引导下FNA联合现场评估和不同的细胞学制片方法可显著提高甲状腺FNA标本的诊断准确性。
