Mihai Radu, Parker Andrew J C, Roskell Derek, Sadler Gregory P
Department of Endocrine Surgery, John Radcliffe Hospital , Oxford, United Kingdom.
Thyroid. 2009 Jan;19(1):33-7. doi: 10.1089/thy.2008.0200.
Fine-needle aspiration (FNA) biopsy is the cornerstone of assessment of thyroid nodules. Cytological criteria for benign (THY2) and malignant (THY5) aspirates are well established and reliable. When cytology suggests a follicular neoplasm (THY3), only formal histological assessment can differentiate between benign and malignant lesions. The objective of this study was to determine the factors predictive of malignancy in thyroid nodules when cytological assessment is restricted to euthyroid patients living in an area without endemic goiter who undergo routine diagnostic lobectomy once the FNA raises the suspicion of a follicular neoplasm.
Retrospective review of histological and clinical data in a cohort of patients with a palpable thyroid nodule and THY3 cytology.
Between January 2000 and December 2007, 1981 patients (346 males and 1635 females) underwent 2809 thyroid FNAs. There were 201 THY3 reports (9%). Histology demonstrated thyroid carcinomas in 57 patients (31 follicular carcinomas, 11 Hurthle cell carcinomas, 11 papillary carcinomas, 1 medullary thyroid carcinoma, 1 poorly differentiated thyroid cancer, 1 lymphoma, and 1 metastatic renal carcinoma). Benign tumors were found in 144 patients with follicular adenomas (n = 76), Hurthle cell adenomas (n = 33), multinodular goiter (n = 13), adenomatoid nodules (n = 15), colloid nodules (n = 4), and thyroiditis (n = 3). THY3 cytology was more predictive of malignancy in men (13/34 male symbol vs. 44/167 female symbol, p < 0.001, chi(2) test). The risk for malignancy was 1:4 for the entire group and 1:3 for patients under 30 years and over 60 years. About 17/46 nodules over 40 mm in diameter were carcinomas, compared with only 35/140 in nodules under 40 mm (p < 0.01, chi2 test).
One in four patients with cytological features of a follicular neoplasm has a thyroid carcinoma. A large nodule (>4 cm) with THY3 cytology has a high likelihood of being a cancer, and arguably such patients could be offered total thyroidectomy rather than diagnostic lobectomy.
细针穿刺（FNA）活检是评估甲状腺结节的基石。良性（THY2）和恶性（THY5）穿刺物的细胞学标准已确立且可靠。当细胞学提示为滤泡性肿瘤（THY3）时，只有通过正式的组织学评估才能区分良性和恶性病变。本研究的目的是确定在细胞学评估仅限于居住在非地方性甲状腺肿地区的甲状腺功能正常患者，且当FNA引发滤泡性肿瘤怀疑时接受常规诊断性叶切除术的情况下，甲状腺结节中预测恶性肿瘤的因素。
对一组可触及甲状腺结节且细胞学为THY3的患者的组织学和临床数据进行回顾性分析。
2000年1月至2007年12月期间，1981例患者（346例男性和1635例女性）接受了2809次甲状腺FNA。有201份THY3报告（9%）。组织学显示57例患者患有甲状腺癌（31例滤泡癌、11例嗜酸性细胞癌、11例乳头状癌、1例髓样甲状腺癌、1例低分化甲状腺癌、1例淋巴瘤和1例转移性肾癌）。在144例患者中发现良性肿瘤，包括滤泡性腺瘤（n = 76）、嗜酸性细胞腺瘤（n = 33）、多结节性甲状腺肿（n = 13）、腺瘤样结节（n = 15）、胶样结节（n = 4）和甲状腺炎（n = 3）。THY3细胞学在男性中更能预测恶性肿瘤（男性13例/34例 vs. 女性44例/167例，p < 0.001，卡方检验）。整个组的恶性风险为1:4，30岁以下和60岁以上患者的恶性风险为1:3。直径超过40 mm的结节中约17/46为癌，而直径小于40 mm的结节中仅35/140为癌（p < 0.01，卡方检验）。
具有滤泡性肿瘤细胞学特征的患者中，四分之一患有甲状腺癌。细胞学为THY3的大结节（>4 cm）很可能是癌症，可以认为这类患者应接受全甲状腺切除术而非诊断性叶切除术。
