Redman Rachel, Zalaznick Hillary, Mazzaferri Ernest L, Massoll Nicole A
Department of Pathology, University of Florida, Gainesville, Florida 32610-0275, USA.
Thyroid. 2006 Jan;16(1):55-60. doi: 10.1089/thy.2006.16.55.
Fine-needle aspiration biopsy (FNAB) of thyroid nodules is a safe, cost-effective procedure but the rates of inadequate cytology specimens range from approximately 1% to 15%. This study tests the hypothesis that ultrasonographically (US) guided FNAB and onsite assessment of cytology improves the adequacy rate of FNAB. A retrospective analysis was performed on 693 thyroid FNAB specimens obtained with and without ultrasound guidance and with or without onsite cytology assessment. Overall, 29 specimens (4%) were inadequate for diagnosis. Among 163 cystic nodules and 530 solid nodules, inadequacy rates were 15% (n = 24) and 1% (n = 5) respectively (p = 0.0001). An onsite assessment of cytology for adequacy was done in 550 cases (83%), which was more accurately performed by a cytopathologist (97%) than a cytotechnologist (93%, p = 0.015). With US-guided FNAB, 3% of the cytology specimens were inadequate, compared to a 7% rate when US was not done (p = 0.003). The mean number of needle punctures necessary for an adequate specimen was 3.8 +/- 0.06 (median, 3.0; range, 1-11), which was different among various types of doctors, ranging from 3.2 +/- 0.07 to 5.4 +/- 0.12 (p = 0.001 analysis of variance [ANOVA]). The fewest number of needle passes to achieve an adequate specimen were required by university endocrinologists and pathologists working together (average, 3.2 +/- 0.07; median, 3.0; range, 1-11). Sample inadequacy rate varied significantly among physician groups, ranging from 3% to 18% (p = 0.0001 ANOVA). Stepwise regression analysis showed that onsite assessment of cytology, US-guided FNAB (p = 0.16), and cystic nature of the nodule (p < 0.0001 for all) correlated with adequacy of the specimen. We conclude that US-guided FNAB with onsite evaluation of cytology specimens substantially increases the adequacy of cytology specimens and decreases the number of required needle passes, which ultimately reduces patient discomfort and diagnostic errors, thus raising the question as to whether this should eventually become the standard of care. We believe this is a goal that training programs should strive to achieve.
甲状腺结节的细针穿刺活检（FNAB）是一种安全且经济有效的检查方法，但细胞学标本不充分的发生率约为1%至15%。本研究检验了以下假设：超声（US）引导下的FNAB及细胞学现场评估可提高FNAB的标本充分率。对693份甲状腺FNAB标本进行了回顾性分析，这些标本有的是在超声引导下获取的，有的不是，有的进行了细胞学现场评估，有的没有。总体而言，29份标本（4%）诊断不充分。在163个囊性结节和530个实性结节中，不充分率分别为15%（n = 24）和1%（n = 5）（p = 0.0001）。550例（83%）进行了细胞学现场评估以确定标本是否充分，细胞病理学家进行评估的准确率更高（97%），高于细胞技术人员（93%，p = 0.015）。在超声引导下进行FNAB时，3%的细胞学标本不充分，而未进行超声引导时这一比例为7%（p = 0.003）。获取充分标本所需的平均穿刺针数为3.8±0.06（中位数为3.0；范围为1 - 11），不同类型的医生之间存在差异，范围从3.2±0.07至5.4±0.12（方差分析[ANOVA]，p = 0.001）。大学内分泌科医生和病理科医生共同操作时获取充分标本所需的穿刺针数最少（平均为3.2±0.07；中位数为3.0；范围为1 - 11）。医生组之间的样本不充分率差异显著，范围从3%至18%（ANOVA，p = 0.0001）。逐步回归分析表明，细胞学现场评估、超声引导下的FNAB（p = 0.16）以及结节的囊性性质（所有p < 0.0001）与标本的充分性相关。我们得出结论，超声引导下的FNAB及细胞学标本现场评估可显著提高细胞学标本的充分率，并减少所需的穿刺针数，最终减少患者的不适和诊断错误，因此引发了这样一个问题，即这最终是否应成为标准的治疗方法。我们认为这是培训项目应努力实现的目标。
