University of Padua, School of Medicine, Department of Surgical and Gastroenterological Sciences, via Giustiniani 2, 35128 Padova, Italy.
Anticancer Res. 2009 Dec;29(12):5255-7.
Patients with solitary thyroid nodules should have fine-needle aspiration (FNA) cytology as the initial screening test, but the most of those referred to a surgeon usually undergo frozen section examination (FS). The aim of this retrospective study was to assess the usefulness of FNA cytology and FS together in patients with a solitary thyroid nodule (TN). Two-hundred and ten patients with a TN and FNA cytology suggesting follicular neoplasm underwent intraoperative FS and subsequent hemithyroidectomy or total thyroidectomy. There were 47 (22.4%) men and 163 (77.6%) women, with a median age of 43 years (range 18-76 years). In all patients, ultrasound-guided FNA was successfully performed using 22-G needle prior to surgery. Smears of the FNA samples were stained by May-Grünwald-Giemsa stain and evaluated immediately by the cytologist. Final histology was follicular carcinoma in 23 (10.9%), follicular adenoma in 181 (86.2%), and hyperplasia in 6 (2.9%) patients. No difference (p=NS) in age of the patients, and greatest diameter on the TN was found between groups. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 13.0%, 97.3%, 37.5%, 90.0%, and 88.1% for FNA cytology, and 17.4%, 100%, 100%, 90.8%, and 91.0% for FS, respectively. The combination of FNA plus FS did not significantly improve the results. In conclusion, both FNA cytology and FS are highly specific tests, but their sensitivity is low, even when they are used in combination. Thus, in patients with smears suggesting follicular neoplasm, FS should be considered unnecessary because it does not affect the intraoperative decision making. FS is most useful in those cases that are diagnosed as suspicious for papillary carcinoma by FNA.
患者有孤立性甲状腺结节应进行细针抽吸（FNA）细胞学作为初始筛选试验，但大多数转介给外科医生的患者通常会进行冰冻切片检查（FS）。本回顾性研究的目的是评估 FNA 细胞学和 FS 在孤立性甲状腺结节（TN）患者中的联合应用的有用性。210 例 FNA 细胞学提示滤泡性肿瘤的 TN 患者接受术中 FS 及随后的甲状腺部分切除术或甲状腺全切除术。其中 47 例（22.4%）为男性，163 例（77.6%）为女性，中位年龄为 43 岁（18-76 岁）。所有患者均在术前使用 22-G 针成功进行了超声引导下 FNA。FNA 样本的涂片用 May-Grünwald-Giemsa 染色，细胞学立即进行评估。最终组织学结果为 23 例（10.9%）滤泡状癌、181 例（86.2%）滤泡性腺瘤和 6 例（2.9%）增生。各组间患者年龄（p=NS）和 TN 最大直径无差异。FNA 细胞学的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 13.0%、97.3%、37.5%、90.0%和 88.1%，FS 分别为 17.4%、100%、100%、90.8%和 91.0%。FNA 联合 FS 并不能显著提高结果。总之，FNA 细胞学和 FS 都是高度特异的检查，但敏感性低，即使联合应用也是如此。因此，对于涂片提示滤泡性肿瘤的患者，FS 应被认为是不必要的，因为它不会影响术中决策。FS 对那些被 FNA 诊断为可疑乳头状癌的病例最有用。
