Division of General Surgery, Robert Wood Johnson Medical School, Office of Surgical Education, University of Medicine and Dentistry of New Jersey, New Brunswick, NJ, USA.
Ann Surg Oncol. 2012 May;19(5):1472-6. doi: 10.1245/s10434-011-2079-3. Epub 2011 Oct 4.
Fine needle aspiration (FNA) is used to diagnose thyroid nodules, but the follow-up of benign FNA is unclear. We sought to determine whether routine repeat FNAs after initial benign FNA reduces false negatives.
We identified 265 patients who had at least one benign FNA that either progressed to surgery or had at least one repeat FNA. We reviewed their ultrasonography, FNA cytology, and surgical pathology.
Of 127 patients with initial benign FNA that had surgery, 13 had a malignancy, yielding a 10.2% false-negative rate. Of 22 patients who had surgery after at least two benign FNAs, one had a malignancy, yielding a 4.5% false-negative rate. Initially benign cytology (Bethesda II) was upgraded to a cytology requiring surgical intervention (Bethesda IV-VI) in 7 of 129 (5.4%) patients after two FNAs. Suspicious features on ultrasound, including size >4 cm, calcifications, or increased vascularity were found in 90% of patients with a false-negative FNA.
The overall false-negative rate of thyroid FNAs is 10.2%, which is reduced to 4.5% with a second benign FNA. Ninety percent of patients with a false-negative FNA had suspicious sonographic features. Reaspiration should be considered in patients with sonographically suspicious nodules.
细针穿刺（FNA）用于诊断甲状腺结节，但良性 FNA 的随访并不明确。我们旨在确定初始良性 FNA 后常规重复 FNA 是否能降低假阴性率。
我们确定了 265 名至少有一次良性 FNA 的患者，这些患者要么进展为手术，要么至少进行了一次重复 FNA。我们回顾了他们的超声、FNA 细胞学和手术病理。
在 127 名初始良性 FNA 后接受手术的患者中，有 13 例为恶性肿瘤，假阴性率为 10.2%。在至少进行了两次良性 FNA 后接受手术的 22 名患者中，有 1 例为恶性肿瘤，假阴性率为 4.5%。在 129 名患者中，有 7 名（5.4%）患者在进行了两次 FNA 后，最初良性的细胞学（Bethesda II 级）升级为需要手术干预的细胞学（Bethesda IV-VI 级）。在假阴性 FNA 的患者中，90%的患者超声显示有可疑特征，包括大小>4cm、钙化或血管增多。
甲状腺 FNA 的总体假阴性率为 10.2%，第二次良性 FNA 可将其降低至 4.5%。假阴性 FNA 的 90%患者有可疑的超声特征。对于超声可疑的结节，应考虑再次抽吸。
