Raj Mariolyn D, Grodski Simon, Martin Sarah Anne, Yeung Meei, Serpell Jonathan W
Monash University Endocrine Surgery Unit, The Alfred Hospital, Prahran, Victoria, Australia.
ANZ J Surg. 2010 Nov;80(11):827-30. doi: 10.1111/j.1445-2197.2010.05343.x.
Diagnosis of thyroid malignancy relies on clinical assessment, imaging and fine-needle aspiration cytology 'FNAC' of thyroid nodules. The purpose of this study was to evaluate how effective synoptically reported FNAC is in clinical practice in diagnosing thyroid cancer. We also examined the effectiveness of using preoperative FNAC results to plan the type of operation for treating thyroid cancer.
A retrospective case series of all patients undergoing thyroid surgery from 1993 to 2008 was analysed. All data were collected prospectively and recorded in a dedicated endocrine surgery database. Data analysed included age, sex, preoperative FNAC result, type of surgery, final histology and complications. Cytology was reported based on a five-tiered classification system.
There were 1373 patients in total and 125 patients with a final diagnosis of thyroid cancer. Female to male ratio was 3:1. Cytology reported as 'malignant' was confirmed as thyroid cancer in 100% of the cases. Of the patients, 47% with 'suspicious' cytology report and 14% with 'follicular/indeterminate' cytology report had a final diagnosis of cancer. Thyroid cancer subtypes were 90 patients with papillary thyroid cancer 'PTC', 24 with follicular 'FTC', eight with medullary 'MTC' and two with anaplastic cancer. Cytology was suggestive of cancer in 89% of the patients with PTC >10 mm, 75% with FTC and 88% with MTC. Transient hypocalcaemia was the commonest complication occurring in 7.2%. There were no cases of permanent hypoparathyroidism. Recurrent laryngeal nerve neuropraxia occurred in 2.4% with a permanent palsy occurring in 0.8%. There were three cancer-related deaths.
Preoperative synoptically reported FNAC is effective when used in diagnosing and planning surgery for thyroid cancer.
甲状腺恶性肿瘤的诊断依赖于临床评估、影像学检查以及甲状腺结节的细针穿刺抽吸活检（FNAC）。本研究的目的是评估在临床实践中，采用概要报告的FNAC对诊断甲状腺癌的有效性。我们还研究了利用术前FNAC结果来规划甲状腺癌手术治疗方式的有效性。
对1993年至2008年期间所有接受甲状腺手术的患者进行回顾性病例系列分析。所有数据均前瞻性收集并记录于一个专门的内分泌外科数据库中。分析的数据包括年龄、性别、术前FNAC结果、手术类型、最终组织学检查结果及并发症情况。细胞学检查报告采用五级分类系统。
总共有1373例患者，其中125例最终诊断为甲状腺癌。男女比例为3:1。细胞学报告为“恶性”的病例中，100%被确诊为甲状腺癌。在患者中，47%细胞学报告为“可疑”以及14%细胞学报告为“滤泡性/不确定”的患者最终被诊断为癌症。甲状腺癌亚型包括90例乳头状甲状腺癌（PTC）、24例滤泡状癌（FTC）、8例髓样癌（MTC）以及2例未分化癌。在直径>10 mm的PTC患者中，89%的细胞学检查提示癌症；FTC患者中为75%；MTC患者中为88%。短暂性低钙血症是最常见的并发症，发生率为7.2%。无永久性甲状旁腺功能减退病例。喉返神经失用症发生率为2.4%，永久性麻痹发生率为0.8%。有3例与癌症相关的死亡病例。
术前采用概要报告的FNAC在诊断甲状腺癌及规划手术治疗时是有效的。
