Cappelli C, Tironi A, Pirola I, Gandossi E, Delbarba A, Agosti B, Castellano M, Agabiti Rosei E
Department of Medical and Surgical Sciences, Internal Medicine and Endocrinology Unit, University of Brescia, 25100 Brescia, Italy.
J Endocrinol Invest. 2008 Jan;31(1):25-8. doi: 10.1007/BF03345562.
Ultrasound fine needle aspiration cytology (US-FNAC) represents the most effective test available to distinguish between benign and malignant thyroid nodules, with an accuracy approaching 95%. The major limit of this procedure it is the rate of inadequate specimens which is reported to be from 10% to 31%. Also because cost considerations have always been important and have recently become even more relevant for clinical guidelines in many countries, it is desirable to limit the number of inadequate samples. Recently, we have shown that the use of stylet needles greatly reduces inadequate cytological specimens in thyroid nodules with an intranodular vascular pattern. With the aim to improve our previous results, we have extended our procedure to all thyroid solid nodules. Between February 2004 and March 2006, 312 consecutive patients with thyroid nodule without intranodular vascular pattern at color-Doppler evaluation were enrolled in this prospective study. US-FNAC was performed by two different 25 gauge needles (Neolus [Ns] and Yale Spinal [YS]), and the two procedures were performed in alternate sequence on consecutive patients. Adequate specimens were observed in 145 (92.9%) and 153 (98%) nodules respectively investigated by Ns and in YS (p<0.005). The total cost to obtain a cytological diagnosis by Ns was of euro 12210.2 (156+12 repeated US-FNAC), whereas it was of euro 12449.7 by YS (156+3 repeated US-FNAC). Our data suggest that spinal needles are associated with a low proportion of inadequate FNAC, without increase of total direct cost, considering also the number of FNAC repetitions needed; therefore, their routine use could be taken into account.
超声细针穿刺细胞学检查（US-FNAC）是鉴别甲状腺结节良恶性最有效的检查方法，准确率接近95%。该检查方法的主要局限性在于标本取材不足率为10%至31%。此外，由于成本因素一直很重要，且最近在许多国家对临床指南变得更加关键，因此限制取材不足样本的数量是可取的。最近，我们发现使用带有针芯的针可大大减少具有结节内血管模式的甲状腺结节中细胞学标本取材不足的情况。为了改进我们之前的结果，我们将该方法扩展到所有甲状腺实性结节。在2004年2月至2006年3月期间，本前瞻性研究纳入了312例在彩色多普勒评估中无结节内血管模式的甲状腺结节连续患者。US-FNAC由两种不同的25号针（Neolus [Ns]和耶鲁脊柱针[YS]）进行，两种操作在连续患者中交替进行。分别用Ns和YS检查的结节中，观察到足够标本的结节数分别为145个（92.9%）和153个（98%）（p<0.005）。通过Ns获得细胞学诊断的总成本为12210.2欧元（156 + 12次重复US-FNAC），而通过YS则为12449.7欧元（156 + 3次重复US-FNAC）。我们的数据表明，考虑到所需的FNAC重复次数，脊柱针与FNAC取材不足的比例较低相关，且不会增加总直接成本；因此，可以考虑将其常规使用。
