Piromalli D, Martelli G, Del Prato I, Collini P, Pilotti S
Division of Diagnostic Oncology and Outpatient Clinic, Istituto Nazionale Tumori, Milan, Italy.
J Surg Oncol. 1992 Aug;50(4):247-50. doi: 10.1002/jso.2930500410.
The utility of fine needle aspiration (FNA) and physical examination for selecting patients with palpable thyroid nodules for surgery was evaluated in 795 consecutive cases. Surgery was performed in 216 patients based upon the cytological diagnosis and clinical criteria. Excluding 42 patients who were lost to follow-up, the remaining 537 were regularly followed up (range, 2-10 years). Cytological findings were classified as malignant, histologic control recommended (suspicious), follicular tumor, benign, and unsatisfactory. Thirty-six aspiration biopsies were positive for malignancy and the diagnosis was confirmed histologically in 34 of them. In 65 patients with final histological diagnosis of malignancy, cytology was positive in 34, suspicious in 20, benign in 3 cases, and unsatisfactory in 8. All patients with cytological diagnosis of follicular tumor had a benign lesion at histology. There were two false positive and three false negative cytological results among the 216 histologically confirmed cases. Excluding unsatisfactory specimen sensitivity, specificity and the predictive value for a positive and a negative result were respectively 95%, 97.5%, 94.5%, and 97%. We conclude that FNA is a very reliable diagnostic test in the evaluation of thyroid nodules and is the best guidance in addition to clinical criteria for selecting patients to be submitted to surgery.
在795例连续病例中，评估了细针穿刺抽吸术（FNA）和体格检查在选择可触及甲状腺结节患者进行手术方面的效用。根据细胞学诊断和临床标准，216例患者接受了手术。排除42例失访患者，其余537例进行了定期随访（范围为2至10年）。细胞学检查结果分为恶性、建议组织学对照（可疑）、滤泡性肿瘤、良性和不满意。36例穿刺活检结果为恶性，其中34例经组织学证实。在最终组织学诊断为恶性的65例患者中，细胞学检查结果为阳性的有34例，可疑的有20例，良性的有3例，不满意的有8例。所有细胞学诊断为滤泡性肿瘤的患者组织学检查均为良性病变。在216例经组织学证实的病例中，有2例假阳性和3例假阴性细胞学结果。排除不满意标本后，敏感性、特异性以及阳性和阴性结果的预测值分别为95%、97.5%、94.5%和97%。我们得出结论，FNA在评估甲状腺结节方面是一种非常可靠的诊断方法，并且是除临床标准外选择患者进行手术的最佳指导。
