Research Institute of Radiological Science, Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea.
Ann Surg Oncol. 2010 Aug;17(8):2147-55. doi: 10.1245/s10434-010-0992-5. Epub 2010 Mar 9.
BACKGROUND: Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is an accurate, reliable, and simple procedure to perform, and it is nowadays accepted as a standard diagnostic method for the differential diagnosis of thyroid nodules. However, a major limitation of US-FNAB is indeterminate cytology results at a thyroid nodule. This study investigated the clinical and US characteristics that predict malignancy, as well as the role of intraoperative frozen sections (FS) in the treatment of thyroid nodules with indeterminate cytology. METHODS: From September 2002 to December 2007, the medical records of 181 patients (185 nodules) with indeterminate FNAB cytology results were retrospectively reviewed. Among them, 99 patients (M:F = 13:86; mean age, 43.71 years) with 99 thyroid nodules underwent subsequent surgery with pathologic confirmation. Seventy-eight patients (78.8%) underwent intraoperative FS. US findings of the surgically proven thyroid nodules were retrospectively reviewed. US features, clinical characteristics, and FS results were compared to the surgically proven pathologic results. RESULTS: Nineteen nodules (19.2%) with indeterminate FNAB cytology were diagnosed as malignant. Lesion size varied from 4 to 70 mm (mean, 27.0 mm). Male patients (46.2%) were more significantly associated with malignancy than female patients (15.1%, P < 0.05). Microlobulated or ill-defined margins (87.5%), microcalcifications (50.0%), and taller-than-wide shape (80.0%) were US features showing correlations with malignancy (P < 0.05). Intraoperative FS significantly predicted malignancy (P < 0.05). Of the 78 cases with FS, 29 cases (37.2%) were deferred. Among the remaining 49 cases, 4 (5.1%) were malignant on FS and subsequent surgical pathology. Forty-five cases (57.7%) were diagnosed as benign on FS, but only two cases were diagnosed as malignant on surgical pathology. CONCLUSIONS: Ultrasound is a feasible method in predicting malignancy in thyroid nodules with indeterminate FNAB cytology. Also, intraoperative FS is a supportive method with high specificity that may guide the treatment of thyroid nodule with indeterminate cytology.
背景：超声引导下细针抽吸活检（FNAB）是一种准确、可靠且简单的操作方法，现已被接受为甲状腺结节鉴别诊断的标准诊断方法。然而，超声引导下 FNAB 的一个主要局限性是甲状腺结节的细胞学结果不确定。本研究旨在探讨预测恶性肿瘤的临床和超声特征，以及术中冰冻切片（FS）在处理细胞学结果不确定的甲状腺结节中的作用。
方法：回顾性分析 2002 年 9 月至 2007 年 12 月间 181 例（185 个结节）细胞学结果不确定的 FNAB 患者的病历资料。其中，99 例（男：女=13：86；平均年龄 43.71 岁）患者的 99 个甲状腺结节接受了后续手术并经病理证实。78 例（78.8%）患者接受了术中 FS。回顾性分析经手术证实的甲状腺结节的超声表现。比较超声特征、临床特征和 FS 结果与手术证实的病理结果。
结果：19 个（19.2%）细胞学结果不确定的 FNAB 结节被诊断为恶性。病变大小为 4 至 70mm（平均 27.0mm）。男性患者（46.2%）比女性患者（15.1%）更显著与恶性肿瘤相关（P<0.05）。微叶状或边界不清（87.5%）、微钙化（50.0%）和高宽比（80.0%）是与恶性肿瘤相关的超声特征（P<0.05）。术中 FS 显著预测恶性肿瘤（P<0.05）。78 例 FS 中，29 例（37.2%）被推迟。在其余 49 例中，4 例（5.1%）在 FS 和随后的手术病理中为恶性。45 例（57.7%）FS 诊断为良性，但仅 2 例手术病理诊断为恶性。
结论：超声是一种可行的方法，可预测细胞学结果不确定的甲状腺结节的恶性肿瘤。此外，术中 FS 是一种特异性高的辅助方法，可能指导细胞学结果不确定的甲状腺结节的治疗。
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