Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Thyroid. 2010 Nov;20(11):1229-34. doi: 10.1089/thy.2009.0443. Epub 2010 Oct 7.
The majority of patients having a diagnosis of Hürthle cell neoplasm (HCN) on fine-needle aspiration (FNA) of a thyroid nodule have a diagnostic thyroid lobectomy to make the final diagnosis. If the nodule is malignant, they require a completion thyroidectomy. The objective of this study was to devise a simple clinical scheme capable of predicting malignancy in patients with cytologic diagnosis of HCN and, therefore, guide the extent of initial thyroid surgery.
A total of 57 patients who underwent thyroid surgery after an FNA diagnosis of HCN were retrospectively studied. The patients were examined for clinical features, preoperative imaging studies, and pathology reports. The risk of malignancy was calculated using a multiple logistic regression model.
The overall rate of malignancy in patients with HCN was 46% (26/57). The predictors of malignancy based on multiple logistic regression analysis were tumor size >1.5 cm (odds ratio [95% confidence interval] = 8.0 [1.9-33.4]) and patient age >45 years (odds ratio [95% confidence interval] = 2.3 [0.6-8.6]). In patients with nodules larger than 1.5 cm, the predicted probability of malignancy was greater in patients over 45 years than in younger patients (65% for >45 years vs. 44% for ≤45 years). In patients with a nodule 1.5 cm or less, the probability of malignancy was relatively low and not significantly different between the two age categories (18% for >45 years vs. 10% for ≤45 years).
This study suggests that tumor size and age can be integrated into decision making for patients with an FNA diagnosis of HCN to facilitate patient selection for surgical referral and, particularly, to determine in which patients a thyroidectomy rather than a lobectomy should be the initial surgery.
大多数在甲状腺结节细针穿刺抽吸术（FNA）中诊断为 Hurthle 细胞肿瘤（HCN）的患者需要进行诊断性甲状腺叶切除术以做出最终诊断。如果结节是恶性的，他们需要完成甲状腺切除术。本研究的目的是设计一种简单的临床方案，能够预测细胞学诊断为 HCN 的患者的恶性肿瘤，并指导初始甲状腺手术的范围。
回顾性研究了 57 例在 FNA 诊断为 HCN 后接受甲状腺手术的患者。对这些患者进行了临床特征、术前影像学检查和病理报告检查。使用多元逻辑回归模型计算恶性肿瘤的风险。
HCN 患者的总体恶性肿瘤发生率为 46%（26/57）。基于多元逻辑回归分析的恶性肿瘤预测因素为肿瘤大小>1.5cm（比值比[95%置信区间]为 8.0[1.9-33.4]）和患者年龄>45 岁（比值比[95%置信区间]为 2.3[0.6-8.6]）。在结节大于 1.5cm 的患者中，年龄大于 45 岁的患者恶性肿瘤的预测概率大于年龄小于等于 45 岁的患者（45 岁以上患者为 65%，45 岁以下患者为 44%）。在结节大小为 1.5cm 或以下的患者中，恶性肿瘤的概率相对较低，且在两个年龄组之间无显著差异（45 岁以上患者为 18%，45 岁以下患者为 10%）。
本研究表明，肿瘤大小和年龄可以整合到 FNA 诊断为 HCN 的患者的决策中，以方便患者选择手术转诊，特别是确定在哪些患者中甲状腺切除术而不是叶切除术应作为初始手术。
