Endocrinology Service, Hospital Universitari Mútua de Terrassa, Plaza Dr. Robert, 5, 08221, Terrassa, Barcelona, Spain.
Endocrine. 2011 Dec;40(3):423-31. doi: 10.1007/s12020-011-9479-9. Epub 2011 May 4.
Since the clinical implementation of fine needle aspiration cytology (FNAC) to diagnose thyroid carcinoma, few patients remain misdiagnosed and little is known about their clinical outcomes. An observational retrospective study was carried out to analyse prognostic factors and follow-up of patients with differentiated thyroid carcinoma (DTC) not disclosed by FNAC before surgery, compared to a control group. From October 2003 to July 2010, 308 patients underwent surgery as treatment for nodular goitre and 53 had DTC. Cases were 12 subjects with DTC and benign (n = 7) or nondiagnostic (n = 5) FNAC. Controls were 39 subjects with DTC and suspicious (n = 19) or malignant (n = 20) FNAC. Prognostic factors, recurrence and survival rates were compared. Cases had longer time from FNAC to surgery than the control group (86.8 ± 74.1 vs. 16.4 ± 23.8 weeks; P < 0.001), higher prevalence of follicular carcinoma (33.3 vs. 2.6%; P = 0.009), and of two-time total thyroidectomy (75 vs. 30.8%; P = 0.016). Average follow-up was 42.7 ± 25.3 months (2-86 months). There were no deaths. Disease-free survival for cases was 66.9 ± 5.8 months, and for controls 78.7 ± 3.9 months (P: ns). In patients with DTC, the result of the FNAC performed before surgery was not an independent predictor of recurrences or mortality in the first 7 years of follow-up. Thus, false negative or nondiagnostic FNAC in a patient with DTC does not seem to be a primary prognostic factor, but it may reveal other adverse prognostic factors such as longer time to therapy and higher prevalence of follicular carcinoma that may influence long-term outcomes.
自从细针穿刺细胞学（FNAC）用于诊断甲状腺癌以来，很少有患者被误诊，而且对他们的临床结果知之甚少。本研究开展了一项观察性回顾性研究，旨在分析手术前 FNAC 未能确诊的甲状腺癌（DTC）患者的预后因素和随访情况，并与对照组进行比较。2003 年 10 月至 2010 年 7 月，308 例患者因甲状腺结节接受手术治疗，其中 53 例为 DTC。DTC 合并良性（n=7）或非诊断性（n=5）FNAC 的病例共 12 例。对照组为 DTC 合并可疑（n=19）或恶性（n=20）FNAC 的 39 例患者。比较了两组患者的预后因素、复发率和生存率。病例组从 FNAC 到手术的时间长于对照组（86.8±74.1 周 vs. 16.4±23.8 周；P<0.001），滤泡状癌的发生率更高（33.3% vs. 2.6%；P=0.009），且二次甲状腺全切除术的比例更高（75% vs. 30.8%；P=0.016）。平均随访时间为 42.7±25.3 个月（2-86 个月）。没有死亡病例。病例组的无病生存率为 66.9±5.8 个月，对照组为 78.7±3.9 个月（P：无统计学意义）。在 DTC 患者中，手术前 FNAC 的结果并不是前 7 年随访中复发或死亡的独立预测因素。因此，在 DTC 患者中 FNAC 结果为假阴性或非诊断性似乎不是主要的预后因素，但它可能揭示了其他不良的预后因素，如治疗时间延长和滤泡状癌的高发，这些因素可能影响长期结局。
