Pu Robert T, Yang Jack, Wasserman Patricia G, Bhuiya Tawfiqul, Griffith Kent A, Michael Claire W
Department of Pathology, Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Diagn Cytopathol. 2006 May;34(5):330-4. doi: 10.1002/dc.20440.
Thyroid fine-needle aspiration (FNA) is a standard procedure for the clinical triage of thyroid nodules. The diagnosis of an adequately sampled thyroid FNA is generally grouped into three categories: benign, malignant, and indeterminate. The latter group usually includes follicular neoplasm, follicular lesion, and sometimes a more specific diagnosis such as Hurthle cell neoplasm or follicular lesion/neoplasm with Hurthle cell change. Whether a FNA diagnosis of Hurthle cell lesion/neoplasm (HLN) denotes a worse clinical outcome than follicular lesion/neoplasm (FLN) remains controversial. A cohort of 303 thyroid FNA cases with follow-up thyroidectomy in our institutes was identified, with the follow-up excision diagnosis compared to the FNA diagnosis in order to address this issue. Of this cohort, 87 cases had an FNA diagnosis of HLN while 216 cases had a diagnosis of FLN. Upon excision, the FNA diagnosis of HLN group had 14 cases of goiter/nodular hyperplasia (16%), 46 cases of adenoma (12 follicular adenoma (14%) and 34 cases of Hurthle cell adenoma (39%)), and 27 cases of carcinoma (31%, 12 papillary carcinoma and 15 Hurthle cell carcinoma). The FLN group had 74 cases of goiter/nodular hyperplasia (34.3%), 8 cases of Hashimoto thyroiditis (3.7%), 73 cases of follicular adenoma (33.8%), one case of granular cell tumor, and 60 cases of carcinoma (27.8%, 46 papillary carcinoma, 12 follicular carcinoma, and 1 Hurthle cell carcinoma and 1 parathyroid carcinoma) upon excision. There is no significant difference in predicting cancer between the two cytology diagnosis groups (HLN versus FLN, 31% versus 27.8%, P = 0.5771). When sorting all the cases by the surgical diagnosis, while comparable for age at diagnosis, the cancer group having the higher proportion of male patients than the non-cancer group (28.7% versus 16.7%, P = 0.0259). Hurthle cell carcinoma patients are typically older than patients with other cancer diagnoses (59 versus 44, P = 0.0077). Our results suggest that an FNA diagnosis of HLN does not predict more malignancy than FLN. Males and older patients with a HLN FNA diagnosis carry a higher risk of Hurthle cell carcinoma upon thyroidectomy.
甲状腺细针穿刺抽吸活检（FNA）是甲状腺结节临床分级的标准程序。充分取样的甲状腺FNA诊断通常分为三类：良性、恶性和不确定。后一组通常包括滤泡性肿瘤、滤泡性病变，有时还包括更具体的诊断，如嗜酸细胞肿瘤或伴有嗜酸细胞改变的滤泡性病变/肿瘤。FNA诊断为嗜酸细胞病变/肿瘤（HLN）是否比滤泡性病变/肿瘤（FLN）的临床预后更差仍存在争议。我们研究机构确定了一组303例接受甲状腺切除术后随访的甲状腺FNA病例，将随访切除诊断与FNA诊断进行比较以解决这个问题。在这组病例中，87例FNA诊断为HLN，216例诊断为FLN。切除术后，HLN组FNA诊断有14例甲状腺肿/结节性增生（16%），46例腺瘤（12例滤泡性腺瘤（14%）和34例嗜酸细胞腺瘤（39%）），27例癌（31%，12例乳头状癌和15例嗜酸细胞癌）。FLN组切除术后有74例甲状腺肿/结节性增生（34.3%），8例桥本甲状腺炎（3.7%），73例滤泡性腺瘤（33.8%），1例颗粒细胞瘤，60例癌（27.8%，46例乳头状癌，12例滤泡癌，1例嗜酸细胞癌和1例甲状旁腺癌）。两组细胞学诊断在预测癌症方面无显著差异（HLN组与FLN组，31%对27.8%，P = 0.5771）。当根据手术诊断对所有病例进行分类时，虽然诊断时年龄相当，但癌症组男性患者比例高于非癌症组（28.7%对16.7%，P = 0.0259）。嗜酸细胞癌患者通常比其他癌症诊断患者年龄更大（59岁对44岁，P = 0.0077）。我们的结果表明，FNA诊断为HLN并不比FLN预测出更多的恶性肿瘤。FNA诊断为HLN的男性和老年患者甲状腺切除术后发生嗜酸细胞癌的风险更高。
