Department of Otolaryngology, Istanbul Training and Research Hospital, Örnek mah Libadiye cad Tahralı sitesi B1 blok, Kat:6 D:27 Usküdar, Istanbul, Turkey.
Eur Arch Otorhinolaryngol. 2012 Jan;269(1):283-7. doi: 10.1007/s00405-011-1588-9. Epub 2011 Apr 11.
The objectives of this study were to determine the predictive value of dominant nodules (DNs) in multinodular goiters (MNGs), and to stratify the risk of malignancy within the indeterminate category. The study design was retrospective study of patients with MNG. A total of 140 patients were reviewed. Fine needle aspiration biopsy (FNAB) findings for all DNs were categorized into four groups: (1) benign, (2) positive or suspicious for malignancy, (3) indeterminate, and (4) non-diagnostic. All FNAB specimens of the indeterminate group were also evaluated for the presence of Hurthle cell metaplasia and were categorized according to the presence of cytological atypia. Cytohistological comparison was then performed. Mean number and diameter of the DNs were 1.45 and 25.6 mm, respectively. Based on final histopathology, 22.14% of the patients had thyroid malignancy and 74.2% of thyroid carcinomas were located in DNs. The number of DNs was significantly larger in malignant thyroid glands than in benign ones. In total, 22.6% of the indeterminate FNABs were malignant. FNABs of the indeterminate group that included atypical cells had a statistically significant higher incidence of malignancy. The presence of Hurthle cells was not statistically different in malignant and benign nodules upon final histological diagnosis. In conclusion, FNAB of only DNs in MNG could determine thyroid malignancy in 75% of patients. The DN number might be required for the predictive value of malignancy. A subclassification of the indeterminate group, based on the presence or absence of cytological atypia, is necessary to better assess the risk of malignancy.
本研究旨在确定多发结节性甲状腺肿（MNG）中优势结节（DN）的预测价值，并对不确定类别中恶性肿瘤的风险进行分层。研究设计为 MNG 患者的回顾性研究。共回顾了 140 名患者。所有 DN 的细针穿刺活检（FNAB）结果分为四组：（1）良性，（2）阳性或可疑恶性，（3）不确定，（4）非诊断性。所有不确定组的 FNAB 标本也评估了 Hurthle 细胞化生的存在，并根据细胞学异型性的存在进行分类。然后进行细胞组织学比较。DN 的平均数量和直径分别为 1.45 和 25.6mm。根据最终组织病理学，22.14%的患者患有甲状腺恶性肿瘤，74.2%的甲状腺癌位于 DN 中。恶性甲状腺中 DN 的数量明显大于良性甲状腺。总的来说，22.6%的不确定 FNAB 是恶性的。包含不典型细胞的不确定 FNAB 的恶性发生率具有统计学意义。在最终的组织学诊断中，恶性和良性结节中 Hurthle 细胞的存在无统计学差异。总之，在 MNG 中仅对 DN 进行 FNAB 可以在 75%的患者中确定甲状腺恶性肿瘤。DN 数量可能是恶性肿瘤预测价值所必需的。有必要对不确定组进行亚分类，基于存在或不存在细胞学异型性，以更好地评估恶性肿瘤的风险。
