Dustin Simone M, Jo Vickie Y, Hanley Krisztina Z, Stelow Edward B
Department of Pathology, University of Virginia, Charlottesville, Virginia, USA.
Diagn Cytopathol. 2012 May;40(5):416-21. doi: 10.1002/dc.21802. Epub 2011 Sep 19.
Fine-needle aspiration (FNA) is a screening and diagnostic tool used to triage the management of thyroid nodules. While FNA has proved to be a sensitive means of detecting common thyroid malignancies, less is known about the sensitivity and positive predictive value (PPV) of FNA for uncommon thyroid malignancies, including anaplastic thyroid carcinomas, medullary thyroid carcinomas, lymphomas, metastatic carcinomas, and other malignancies. We reviewed our experience with these uncommon malignancies sampled by thyroid FNA and recorded interpretations according to the Bethesda System. We compared the FNA interpretations to the follow-up cytology, histology, and flow cytometry. The sensitivity and PPV were as follows: anaplastic thyroid carcinoma (sensitivity 100%, PPV 89%), lymphoma (sensitivity 100%, PPV 100%), medullary thyroid carcinoma (sensitivity 83%, PPV 100%), metastatic carcinoma (sensitivity 80%, PPV 80%), and other malignancy (sensitivity 100%, PPV 100%). Four false-negative and two false-positive diagnoses were identified. While cases were nearly always triaged correctly, occasional pitfalls were encountered.
细针穿刺抽吸活检（FNA）是一种用于对甲状腺结节管理进行分类的筛查和诊断工具。虽然FNA已被证明是检测常见甲状腺恶性肿瘤的一种敏感方法，但对于FNA检测罕见甲状腺恶性肿瘤（包括未分化甲状腺癌、髓样甲状腺癌、淋巴瘤、转移性癌和其他恶性肿瘤）的敏感性和阳性预测值（PPV），人们了解较少。我们回顾了通过甲状腺FNA取样的这些罕见恶性肿瘤的病例，并根据贝塞斯达系统记录诊断结果。我们将FNA诊断结果与后续的细胞学、组织学和流式细胞术结果进行了比较。敏感性和PPV如下：未分化甲状腺癌（敏感性100%，PPV 89%）、淋巴瘤（敏感性100%，PPV 100%）、髓样甲状腺癌（敏感性83%，PPV 100%）、转移性癌（敏感性80%，PPV 80%）和其他恶性肿瘤（敏感性100%，PPV 100%）。发现了4例假阴性和2例假阳性诊断。虽然病例几乎总是能被正确分类，但偶尔也会遇到一些问题。
