Cappelli Carlo, Castellano Maurizio, Pirola Ilenia, Gandossi Elena, De Martino Elvira, Cumetti Davide, Agosti Barbara, Rosei Enrico Agabiti
Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, c/o 2 Medicina Spedali Civili di Brescia, Piazzale Spedali Civili no.1, 25100 Brescia, Italy.
Eur J Endocrinol. 2006 Jul;155(1):27-31. doi: 10.1530/eje.1.02177.
To evaluate if a nodule with shape taller than wide (anteroposterior/transverse diameter ratio, A/T > or = 1) is a good predictor of malignancy independent of the size.
We retrospectively examined the cytological and histological results of 7455 nodules (5198 patients) referred for ultrasound-guided-fine needle aspiration cytology (US-FNAC) in our hospital from January 1991 to September 2004.
A suitable FNAC was obtained from 6135 nodules (4495 patients); 34.6% were less than 1 cm in diameter (small nodules, SN). A diagnosis of carcinoma was histologically confirmed in 284/349 suspicious lesions after FNAC. The size of carcinoma nodules was not significantly associated with the occurrence of extracapsular growth (large nodules (LN): 10.5%, SN: 4.9%, NS) and lymph node metastasis (LN: 23.6%, SN: 25.0%, NS). Malignant lesions showed microcalcifications more frequently than benign nodules (72.2 vs 28.7%; P < 0.001; (odds ratio, OR(confidence intervals, CI) = 9.9(7.2-13.4)). Similarly, A/T > or = 1 (76 vs 40%; P < 0.001; OR(CI) = 8.6(5.5-13.1)), blurred margins (52.8 vs 18.8%; P < 0.001; OR(CI) = 7.7(5.6-10.2)), solid hypo-echoic appearance (80.6 vs 52.4%; P < 0.001; OR(CI) = 3.2(2.2-4.3)) and intranodular vascular pattern (type 2) (61.6 vs 49.7%; P < 0.001; OR(CI) = 1.7(1.3-2.3)) were significantly more frequent in malignant than in benign nodules.
Our data show that no single parameter, including nodule size, satisfactorily identifies a subset of patients to be electively investigated by FNAC. We concluded that A/T > or = 1 with at least two of US features (microcalcification, blurred margins, hypo-echoic pattern) is today the best compromise between missing cancers and cost-benefit.
评估前后径/横径比（A/T）≥1的结节是否是一个独立于大小的良好恶性预测指标。
我们回顾性分析了1991年1月至2004年9月在我院接受超声引导下细针穿刺细胞学检查（US-FNAC）的7455个结节（5198例患者）的细胞学和组织学结果。
从6135个结节（4495例患者）中获得了合适的FNAC样本；34.6%的结节直径小于1cm（小结节，SN）。FNAC后，284/349个可疑病变经组织学确诊为癌。癌结节的大小与包膜外生长的发生率（大结节（LN）：10.5%，SN：4.9%，无显著性差异）和淋巴结转移（LN：23.6%，SN：25.0%，无显著性差异）无显著相关性。恶性病变比良性结节更频繁地出现微钙化（72.2%对28.7%；P<0.001；优势比，OR（置信区间，CI）=9.9（7.2-13.4））。同样，A/T≥1（76%对40%；P<0.001；OR（CI）=8.6（5.5-13.1））、边界模糊（52.8%对18.8%；P<0.001；OR（CI）=7.7（5.6-10.2））、实性低回声表现（80.6%对52.4%；P<0.001；OR（CI）=3.2（2.2-4.3））和结节内血管模式（2型）（61.6%对49.7%；P<0.001；OR（CI）=1.7（1.3-2.3））在恶性结节中比良性结节显著更常见。
我们的数据表明，没有单一参数，包括结节大小，能令人满意地识别出需要通过FNAC进行选择性检查的患者亚组。我们得出结论，A/T≥1且至少具备超声特征（微钙化、边界模糊、低回声模式）中的两项，是目前在漏诊癌症和成本效益之间的最佳折衷方案。
