Bakshi Nasir A, Mansoor Ibrahim, Jones Bruce A
Department of Pathology, St John Hospital and Medical Center, Detroit, MI, USA.
Endocr Pathol. 2003 Summer;14(2):167-75. doi: 10.1385/ep:14:2:167.
To evaluate all inconclusive fine-needle aspiration biopsy (FNAB) specimens from thyroid follicular lesions with subsequent histologic diagnosis at St John Hospital and Medical Center, Detroit, MI. The criterion for specimen adequacy used in our institution was also reexamined to determine whether it was too stringent. We reviewed 45 inconclusive FNAB samples. Only cases that underwent surgical intervention were considered. Specimen adequacy was determined by the presence of at least 8-10 tissue fragments of well-preserved follicular epithelium on at least two slides; each tissue fragment should have a minimum of 8-10 cells. Different cytologic characteristics-cellularity, cellular architecture, nuclear pleomorphism, inclusion/grooves, chromatin, Hürthle cell change, lymphocytes, macrophages, colloid, and multinucleated giant cells-were scored and compared with final surgical diagnosis. The surgical procedure performed was also analyzed. Review of these 45 surgical specimens found 28 (62.2%) multinodular goiters, 14 (31.1%) nodular hyperplasias, 2 (4.4%) follicular adenomas, and one (2.2%) with invasive follicular carcinoma. Forty-three (95.6%) of these cases were female and 2 (4.4%) were male. Cytologic review showed 2 acellular samples, 10 cases containing macrophages only, 10 aspirates with macrophages and an inadequate number of follicular cells, and 23 specimens with an inadequate number of follicular cells. Twenty-three patients underwent total thyroidectomy; 20, lobectomy; and 2, isthumusectomy. Almost 98% of the patients with inconclusive FNAB had benign lesions. This finding encouraged us to continue using our criteria for adequacy because of the importance of a negative report. Patients in our series, who underwent thyroidectomy after an inconclusive or nondiagnostic aspirate, had a malignancy rate of 2.2%, which was no worse than patients with a benign preoperative diagnosis. A balanced approach with careful follow-up for nondiagnostic cytology is prudent.
为评估底特律圣约翰医院及医疗中心所有经细针穿刺活检（FNAB）结果不确定的甲状腺滤泡性病变标本，并进行后续组织学诊断。我们还重新审视了本机构使用的标本充足性标准，以确定其是否过于严格。我们回顾了45份FNAB结果不确定的样本。仅纳入接受手术干预的病例。标本充足性通过至少两张载玻片上存在至少8 - 10个保存良好的滤泡上皮组织碎片来确定；每个组织碎片应至少有8 - 10个细胞。对不同的细胞学特征——细胞密度、细胞结构、核多形性、包涵体/沟、染色质、许特莱细胞改变、淋巴细胞、巨噬细胞、胶质和多核巨细胞进行评分，并与最终手术诊断结果进行比较。还对所实施的手术过程进行了分析。对这45份手术标本的回顾发现，28例（62.2%）为结节性甲状腺肿，14例（31.1%）为结节性增生，2例（4.4%）为滤泡性腺瘤，1例（2.2%）为侵袭性滤泡癌。这些病例中43例（95.6%）为女性，2例（4.4%）为男性。细胞学检查显示，2份样本无细胞，10例仅含巨噬细胞，10份吸出物中有巨噬细胞且滤泡细胞数量不足，23份标本中滤泡细胞数量不足。23例患者接受了全甲状腺切除术；20例接受了甲状腺叶切除术；2例接受了甲状腺峡部切除术。几乎98%的FNAB结果不确定的患者患有良性病变。这一发现鼓励我们继续使用我们的充足性标准，因为阴性报告很重要。在我们的系列研究中，在穿刺结果不确定或无法诊断后接受甲状腺切除术的患者，恶性肿瘤发生率为2.2%，并不比术前诊断为良性的患者更差。对于无法诊断的细胞学检查采取谨慎的后续密切随访的平衡方法是明智的。
