Elliott Danielle D, Pitman Martha B, Bloom Leonard, Faquin William C
Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2006 Apr 25;108(2):102-9. doi: 10.1002/cncr.21716.
Lesions of the thyroid gland composed of Hurthle cells encompass pathologic entities ranging from hyperplastic nodules with Hurthle cell metaplasia to Hurthle cell carcinomas. The cytologic distinction between these entities can be diagnostically challenging. Many cytologic features of Hurthle cell lesions that distinguish neoplastic Hurthle cell lesions requiring surgery from those that are benign and nonneoplastic have been described, but with variable usefulness. This is due, in part, to the small numbers of cases examined in previous studies and the limited application of statistical analysis. A morphologic study was made of 139 Hurthle cell lesions of the thyroid gland and statistical analysis applied to identify a set of cytomorphologic features that distinguish benign Hurthle cell lesions (BHCL) from Hurthle cell neoplasms (HCN).
Fine-needle aspiration biopsies (FNABs) of thyroid nodules with a predominant Hurthle cell component and corresponding histologic followup were included in the study. Cases were divided into BHCL and HCN groups on the basis of the histologic diagnosis. All cases were reviewed to assess the following 14 cytologic features: overall cellularity, cytoarchitecture, percentage of Hurthle cells, percentage of single cells, percentage of follicular cells observed as naked Hurthle cell nuclei, background colloid, chronic inflammation, cystic change, transgressing blood vessels (TBV), intracytoplasmic lumina, presence of multinucleated Hurthle cells, nuclear to cytoplasmic ratio, nuclear pleomorphism/atypia, and nucleolar prominence. The results were evaluated by using univariate and stepwise logistic regression (SLR) analysis; statistical significance was achieved at P-values < 0.05.
One hundred thirty-nine FNAB specimens, corresponding to 56 HCN and 83 BHCL, fulfilled the study criteria. Six of the 14 cytologic features evaluated were shown by univariate analysis to be statistically significant in predicting HCN: nonmacrofollicular architecture (P < 0.001), absence of background colloid (P < 0.001), absence of chronic inflammation (P < 0.001), presence of TBV (P < 0.001), > 90% Hurthle cells (P < 0.001), and >10% single Hurthle cells (P = 0.014). The first four of these features were also shown to be statistically significant in the SLR analysis (P = 0.005, 0.010, 0.016, and 0.045, respectively), and when all four of these features were present HCN was correctly identified 86% of the time.
In the current study of 139 FNAB specimens of thyroid Hurthle cell nodules, 14 cytologic features were examined and 6 were found to be statistically significant in identifying HCN. The following four features, when found in combination, were found to be highly predictive of HCN: nonmacrofollicular architecture, absence of colloid, absence of inflammation, and presence of TBV.
由许特莱细胞构成的甲状腺病变涵盖了从伴有许特莱细胞化生的增生性结节到许特莱细胞癌等一系列病理实体。这些实体之间的细胞学鉴别在诊断上具有挑战性。许多用于区分需要手术的肿瘤性许特莱细胞病变与良性非肿瘤性病变的许特莱细胞病变的细胞学特征已被描述，但实用性各异。这部分是由于既往研究中所检查的病例数量较少以及统计分析的应用有限。对139例甲状腺许特莱细胞病变进行了形态学研究，并应用统计分析来确定一组区分良性许特莱细胞病变（BHCL）与许特莱细胞肿瘤（HCN）的细胞形态学特征。
本研究纳入了以许特莱细胞成分为主的甲状腺结节的细针穿刺活检（FNAB）标本以及相应的组织学随访结果。根据组织学诊断将病例分为BHCL组和HCN组。对所有病例进行复查以评估以下14项细胞学特征：总体细胞量、细胞结构、许特莱细胞百分比、单个细胞百分比、观察到为裸露许特莱细胞核的滤泡细胞百分比、背景胶质、慢性炎症、囊性变、侵犯血管（TBV）、胞质内管腔、多核许特莱细胞的存在、核质比、核多形性/异型性以及核仁突出程度。通过单因素和逐步逻辑回归（SLR）分析对结果进行评估；P值<0.05时具有统计学意义。
139份FNAB标本符合研究标准，其中56例为HCN，83例为BHCL。单因素分析显示，所评估的14项细胞学特征中有6项在预测HCN方面具有统计学意义：非大滤泡结构（P<0.001）、无背景胶质（P<0.001）、无慢性炎症（P<0.001）、存在TBV（P<0.001）、>90%的许特莱细胞（P<0.001）以及>10%的单个许特莱细胞（P = 0.014）。SLR分析显示，其中前四项特征也具有统计学意义（分别为P = 0.005、0.010、0.016和0.045），当这四项特征均存在时，86%的情况下能正确识别HCN。
在当前对139例甲状腺许特莱细胞结节的FNAB标本的研究中，检查了14项细胞学特征，发现其中6项在识别HCN方面具有统计学意义。以下四项特征联合出现时，对HCN具有高度预测性：非大滤泡结构、无胶质、无炎症以及存在TBV。
