Endocrine Unit, Medical Department, San Giuseppe Hospital, AUSL11 Tuscany Region - National Health Service, Empoli (Florence), Italy.
J Endocrinol Invest. 2011 Jul-Aug;34(7):e183-7. doi: 10.3275/7416. Epub 2010 Dec 15.
To determine the need of total thyrodectomy for patients with follicular nodules of thyroid.
From January 2005 through June 2008, 2249 consecutive patients (438 males, 1811 females; mean age 54 yr, range 9-87) with thyroid nodules were submitted to 2518 ultrasound-guided fine-needle aspiration (USgFNA) for cytological examination. USgFNA were performed by experienced surgeon (RP) and endocrinologist (RGG) under ultra- sonographyc guidance, using a 10-MHz linear transducer. Liquid-based cytology was used.
All cytological samples were classified in 5 diagnostic classes (THY1, THY2, THY3, THY4, THY5) in agreement with the British Thyroid Association (BTA); 1.4% specimen were classified as THY5, 2.1% as THY4, 7.6% as THY3, 79.5% as THY2 and 9.4% as THY1. In 97% of THY5 patients, malignancy was found. Among THY4 patients, 95.5% were positive for thyroid tumor. Among THY3 patients, malignancy was found in 29.1%. THY3 patients with thyroid tumors were younger than those with benign lesions (46 ± 14.1 yr vs 50 ± 13.8 yr; p<0.05, t test). No statistical difference was found neither in malignancy frequency among men and women nor in mean size of nodules (24 ± 11.8 mm malignant vs 23 ± 9.4 mm benign).
this study provides evidence that USgFNA offers a very sensitive and accurate method in reducing THY1 samples and in detecting malignancy (>95% both in THY5 and THY4, and >29% in THY3 lesions). Our proposal is to submit to total thyroidectomy all patients with THY5 and THY4 lesions and THY3 thyroid nodule >1 cm.
确定甲状腺滤泡结节患者行甲状腺全切除术的必要性。
2005 年 1 月至 2008 年 6 月，2249 例连续就诊的甲状腺结节患者（男 438 例，女 1811 例；平均年龄 54 岁，范围 9-87 岁）接受了 2518 例超声引导下细针抽吸细胞学检查（USgFNA）。USgFNA 由经验丰富的外科医生（RP）和内分泌医生（RGG）在超声引导下使用 10MHz 线性探头进行。采用液基细胞学。
所有细胞学标本均按照英国甲状腺协会（BTA）的标准分为 5 种诊断类别（THY1、THY2、THY3、THY4、THY5）；1.4%的标本为 THY5，2.1%为 THY4，7.6%为 THY3，79.5%为 THY2，9.4%为 THY1。在 97%的 THY5 患者中发现了恶性肿瘤。THY4 患者中，95.5%为甲状腺肿瘤阳性。THY3 患者中，恶性肿瘤占 29.1%。THY3 患者中甲状腺肿瘤的年龄小于良性病变（46±14.1 岁 vs 50±13.8 岁；p<0.05，t 检验）。在男性和女性的恶性肿瘤发生率以及结节的平均大小（恶性肿瘤 24±11.8mm 与良性肿瘤 23±9.4mm）之间无统计学差异。
本研究表明，USgFNA 可作为一种非常敏感和准确的方法，减少 THY1 样本，并检测恶性肿瘤（THY5 和 THY4 中均>95%，THY3 病变中>29%）。我们的建议是对所有 THY5 和 THY4 病变以及>1cm 的 THY3 甲状腺结节患者行甲状腺全切除术。
