Kikuchi S, Perrier N D, Ituarte P H G, Treseler P A, Siperstein A E, Duh Q-Y, Greenspan F S, Clark O H
Medical Staff Unit, Japan Defense Agency, Shinjuku-ku, Tokyo, Japan.
Br J Surg. 2003 Jun;90(6):755-8. doi: 10.1002/bjs.4198.
Fine-needle aspiration cytology (FNAC) is useful for selecting patients with thyroid nodules for thyroidectomy. Its value in patients who have been exposed to low-dose therapeutic radiation is questionable because these patients have an increased risk of multifocal benign and malignant tumours, and thyroid cancer is common in such patients.
Between 1960 and 1999, 171 patients with one or more thyroid nodules who had a history of exposure to radiation underwent operation; 49 of these patients had preoperative FNAC. The cytology results in these 49 patients were compared with those of an age- and sex-matched control group of patients with thyroid nodules who did not have a history of radiation exposure.
Of those who had been exposed to radiation, six of 20 patients with 'benign' cytology by FNAC and six of 16 patients with 'suspicious' cytology had thyroid cancer. All 13 specimens considered to be malignant on FNAC were indeed malignant. There was a higher rate of false-negative cytological examinations among patients with a history of irradiation that in those without.
FNAC of thyroid nodules in patients with a history of irradiation is not as accurate as that in non-irradiated patients, primarily because of coexisting occult thyroid cancers.
细针穿刺细胞学检查（FNAC）有助于筛选出需要进行甲状腺切除术的甲状腺结节患者。其在接受低剂量治疗性辐射的患者中的价值存在疑问，因为这些患者发生多灶性良性和恶性肿瘤的风险增加，且甲状腺癌在这类患者中很常见。
1960年至1999年间，171例有甲状腺结节且有辐射暴露史的患者接受了手术；其中49例患者术前行FNAC。将这49例患者的细胞学检查结果与年龄和性别匹配的无辐射暴露史的甲状腺结节患者对照组的结果进行比较。
在有辐射暴露史的患者中，FNAC检查结果为“良性”的20例患者中有6例、检查结果为“可疑”的16例患者中有6例患有甲状腺癌。FNAC检查认为恶性的所有13份标本确实为恶性。有辐射暴露史的患者中细胞学检查假阴性率高于无辐射暴露史的患者。
有辐射暴露史患者的甲状腺结节FNAC检查不如未接受辐射患者准确，主要原因是存在隐匿性甲状腺癌。
