Yang Grace C H, Liebeskind Doreen, Messina Albert V
Department of Pathology, New York University School of Medicine, New York, New York, USA.
Cancer. 2003 Apr 25;99(2):69-74. doi: 10.1002/cncr.10957.
As the consequence of the decreasing incidence of follicular thyroid carcinoma (FC), one wonders whether cytopathologists should stop reporting follicular neoplasms in fine-needle aspiration (FNA) of the thyroid to minimize unnecessary thyroidectomies, if the follicular variant of papillary carcinoma (FVPC) has been excluded.
Over a 6-year-period, 2667 ultrasound-guided FNAs of the thyroid were performed at our practice. A total of 246 nodules (9.2%) were reported as follicular neoplasms, using abundant blood as the diagnostic clue. All FNA specimens were prepared and reported by one cytopathologist and the final pathology was reported by surgical pathologists in various hospitals in New York City.
The histologic follow-up was available for 147 cases and showed 5 cases of widely invasive FC (3.4%), 10 cases of minimally invasive FC (6.8%), 8 cases of FVPC (5.4%), 92 cases of follicular adenoma (62.6%), and 32 cases of nonneoplastic nodules (21.8%).
FVPC cannot be excluded completely from follicular neoplasms by FNA because of the patchy distribution of papillary carcinoma nuclei in the encapsulated variant. Widely invasive FC still exists and may cause considerable morbidity in patients as young as the third decade of life. It is the opinion of the authors that cytopathologists should continue reporting follicular neoplasms in FNA of the thyroid.
由于滤泡状甲状腺癌（FC）的发病率下降，有人不禁要问，如果已排除乳头状癌的滤泡状变体（FVPC），细胞病理学家是否应停止在甲状腺细针穿刺活检（FNA）中报告滤泡状肿瘤，以尽量减少不必要的甲状腺切除术。
在我们的诊所，6年期间共进行了2667次超声引导下的甲状腺FNA。共有246个结节（9.2%）被报告为滤泡状肿瘤，以丰富的血液作为诊断线索。所有FNA标本均由一名细胞病理学家制备和报告，最终病理由纽约市各医院的外科病理学家报告。
147例有组织学随访结果，显示5例广泛浸润性FC（3.4%），10例微浸润性FC（6.8%），8例FVPC（5.4%），92例滤泡性腺瘤（62.6%），32例非肿瘤性结节（21.8%）。
由于乳头状癌细胞核在包膜型中的分布呈斑片状，FNA无法完全排除FVPC与滤泡状肿瘤。广泛浸润性FC仍然存在，可能在年仅三十多岁的患者中导致相当大的发病率。作者认为，细胞病理学家应继续在甲状腺FNA中报告滤泡状肿瘤。
