Caprara G, Collina G
Dipartimento di Scienze Oncologiche, Sezione di Anatomia, Istologia e Citologia Patologica "Marcello Malpighi", Ospedale Bellaria, Università di Bologna, Italy.
Pathologica. 2007 Jun;99(3):65-8.
Preoperative identification of the aggressive variants of papillary thyroid carcinoma (PTC) by fine needle aspiration (FNAC) has been suggested and different systems for distinguishing them from classical variant of PTC have been employed, including a point-based cytology grading system as suggested by Damiani et al., that we currently use in our Institution. The aim of this paper is to verify if distinction of PTC in aggressive or nonaggressive variants impacts on surgical treatment. In 7 years, from 1998 to 2005, 13586 cases of FNAC of thyroid have been performed; among them 156 PTC. The cytological material of thirty complete thyroidectomies with histology proven papillary thyroid carcinoma were reviewed. 11/30 cases were correctly stratified into the appropriate low or high-grade category. The cytological grading system was discordant with the final histopathological diagnosis in 9/30 cases while in 10 cases the grade was not assessed. Eight cases were downgraded and therefore the low grade papillary carcinoma diagnosed at cytological level turned to be high grade at histology. When those cases were reviewed, the histology of seven cases diagnosed as tall cell variant of PTC failed to show a percentage of tumour cells higher than 50% and therefore it would be better to diagnose them as classical variant of PTC. One case was under-graded at FNAC. The case that was cytologically upgraded was a follicular variant of PTC in Hashimoto thyroiditis with a focus of tall cells. All patients underwent thyroidectomy or thyroidectomy plus lymphadenectomy and from our results the pre-operative diagnosis did not effect the surgical treatment. No patient died of the disease.
有人建议通过细针穿刺抽吸活检（FNAC）对甲状腺乳头状癌（PTC）的侵袭性变体进行术前识别，并且已经采用了不同的系统来将它们与PTC的经典变体区分开来，包括Damiani等人建议的基于点数的细胞学分级系统，我们目前在我们的机构中使用该系统。本文的目的是验证将PTC区分为侵袭性或非侵袭性变体是否会影响手术治疗。在1998年至2005年的7年中，共进行了13586例甲状腺FNAC；其中156例为PTC。回顾了30例经组织学证实为甲状腺乳头状癌的全甲状腺切除术的细胞学材料。11/30例被正确分层到适当的低级别或高级别类别。在9/30例中，细胞学分级系统与最终的组织病理学诊断不一致，而在10例中未评估分级。8例被降级，因此在细胞学水平诊断为低级别乳头状癌的病例在组织学上变为高级别。当对这些病例进行复查时，7例被诊断为PTC高细胞变体的病例的肿瘤细胞百分比未超过50%，因此将它们诊断为PTC的经典变体可能更好。1例在FNAC时分级过低。在细胞学上被升级的病例是桥本甲状腺炎伴高细胞灶的PTC滤泡变体。所有患者均接受了甲状腺切除术或甲状腺切除术加淋巴结清扫术，从我们的结果来看，术前诊断并未影响手术治疗。没有患者死于该疾病。
