Faquin William C
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Head Neck Pathol. 2009 Mar;3(1):82-5. doi: 10.1007/s12105-009-0104-7. Epub 2009 Feb 22.
Over the past 3 decades, fine needle aspiration (FNA) has developed as the most accurate and cost-effective initial method for guiding the clinical management of patients with thyroid nodules. Thyroid FNA specimens containing follicular-patterned lesions are the most commonly encountered and include various forms of benign thyroid nodules, follicular carcinomas, and the follicular variant of papillary thyroid carcinoma. Based primarily upon the cytoarchitectural pattern, FNA is used as a screening test for follicular-patterned lesions to identify the majority of patients with benign nodules who can be managed without surgical intervention. The terminology and reporting of thyroid FNA results have been problematic due to significant variation between laboratories, but the recent multidisciplinary NCI Thyroid FNA State of the Science Conference has provided a seven-tiered diagnostic solution. A key element of this approach is the category "atypical cells of undetermined significance" (ACUS) which is used for those aspirates which cannot be easily classified as benign, suspicious, or malignant. Lesions in this category represent approximately 3-6% of thyroid FNAs and have a risk of malignancy intermediate between the "benign" category and the "suspicious for a follicular neoplasm" category. The recommended follow-up for an ACUS diagnosis is clinical correlation and in most cases, repeat FNA sampling.
在过去30年里，细针穿刺抽吸活检（FNA）已发展成为指导甲状腺结节患者临床管理的最准确且最具成本效益的初始方法。含有滤泡样病变的甲状腺FNA标本最为常见，包括各种形式的良性甲状腺结节、滤泡癌以及甲状腺乳头状癌的滤泡变体。FNA主要基于细胞结构模式，用作滤泡样病变的筛查试验，以识别大多数可无需手术干预进行管理的良性结节患者。由于各实验室之间存在显著差异，甲状腺FNA结果的术语和报告一直存在问题，但最近的多学科美国国立癌症研究所甲状腺FNA科学现状会议提供了一种七级诊断解决方案。这种方法的一个关键要素是“意义不明确的非典型细胞”（ACUS）类别，用于那些不易归类为良性、可疑或恶性的抽吸物。该类别中的病变约占甲状腺FNA的3 - 6%，其恶性风险介于“良性”类别和“可疑滤泡性肿瘤”类别之间。对于ACUS诊断，推荐的后续措施是临床关联，在大多数情况下，重复FNA采样。
