Unit of General Surgery and Organ Transplantation, Department of Surgical Science, University Hospital of Parma, Parma, Italy.
J Endocrinol Invest. 2011 May;34(5):345-8. doi: 10.1007/BF03347457. Epub 2010 Jun 28.
Pre-operative cytology in thyroid disease remains the most appropriate diagnostic test for defining the nature of a thyroid nodule before surgical excision.
We selected the most recent 825 surgical thyroid procedures performed in our institution from January 2004 to June 2007; 776 were total thyroidectomies, 23 were lobe-isthmectomies, and 26 were radical neck dissections. We distributed the data based on pre-operative cytology. Each cytological diagnosis was compared to results obtained by definitive histology. Tumors were called incidentalomas if they consisted of a neoplastic focus with a low grade of aggressiveness, as demonstrated by dimension <5 mm, non-aggressive histological subtype.
Of the 541 cases of benign disease, 417 were confirmed as benign. The other 124 cases are listed as follows: 29 follicular adenoma; 76 papillary carcinoma (35 found as incidentalomas), and 19 follicular carcinoma (3 incidentalomas). Cytology suggestive of papillary carcinoma was correct in 95.2% of cases (119/125). The 135 tumors termed "follicular neoplasm" were staged on pathology thus: 56 adenoma (41.4%), 26 carcinoma (19.2%), 13 (9.6%) absence of follicular proliferation, 38 (28.1%) papillary follicular variant, 2 (1.4%) undifferentiated cells. Medullary carcinomas were both confirmed. The "suspicious group" exhibited no malignancy on fine needle aspiration cytology (12 of 21; 57%).
Cytology has good reliability in malignant lesions. Incidental tumors occurring in benign disease have little impact on clinical and surgical management; "follicular neoplasm" posed two problems - the impossibility of identifying the nature of the tumor, as well as the newer difficulty in distinguishing papillary follicular subtype.
甲状腺疾病的术前细胞学检查仍然是在手术切除前确定甲状腺结节性质的最适当的诊断试验。
我们选择了 2004 年 1 月至 2007 年 6 月期间在我们机构进行的最近的 825 例甲状腺手术；776 例为全甲状腺切除术，23 例为叶-峡部切除术，26 例为根治性颈部淋巴结清扫术。我们根据术前细胞学检查结果对数据进行了分类。将每种细胞学诊断与明确的组织学结果进行比较。如果肿瘤的侵袭性低，大小<5mm，组织学亚型无侵袭性，则称为偶发瘤。
在 541 例良性疾病中，417 例得到证实为良性。其余 124 例如下：29 例滤泡性腺瘤；76 例乳头状癌（其中 35 例为偶发瘤），19 例滤泡状癌（其中 3 例为偶发瘤）。提示为乳头状癌的细胞学检查在 95.2%的病例中是正确的（119/125）。135 例被称为“滤泡性肿瘤”的肿瘤在病理学上分为：56 例腺瘤（41.4%），26 例癌（19.2%），13 例（9.6%）滤泡增生缺失，38 例（28.1%）乳头滤泡变异型，2 例（1.4%）未分化细胞。髓样癌均得到证实。细针穿刺细胞学检查的“可疑组”（21 例中的 12 例；57%）没有恶性肿瘤。
细胞学检查在恶性病变中有良好的可靠性。在良性疾病中偶发肿瘤对临床和手术管理影响不大；“滤泡性肿瘤”存在两个问题-无法确定肿瘤的性质，以及难以区分乳头状滤泡亚型。
