Chung Jin, Youk Ji Hyun, Kim Jeong-Ah, Kwak Jin Young, Kim Eun-kyung, Ryu Young Hoon, Son Eun Ju
Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea.
Acta Radiol. 2012 Mar 1;53(2):168-73. doi: 10.1258/ar.2011.110133. Epub 2011 Oct 3.
Ultrasound (US)-guided fine needle aspiration cytology (FNAC) is an accurate, reliable, and simple method to identify a thyroid nodule as benign or malignant. However, non-diagnostic cytology results for thyroid nodules are a major limitation of US-guided FNAC.
To investigate the incidence of thyroid cancer among cases with non-diagnostic results on FNAC and to provide suggestions for the management of thyroid nodules that are initially non-diagnostic by FNAC according to ultrasonographic findings.
From July 2006 to December 2009, 10,317 thyroid nodules in 6684 consecutive patients underwent US-guided FNAC at our institute. Among these, 871 thyroid nodules (8.4%) were diagnosed as non-diagnostic on initial cytologic evaluation and 196 underwent a second or third FNAC. Twenty-seven thyroid nodules (18.9%) underwent surgery, while 116 thyroid nodules were cytologically confirmed as benign with no remarkable change on follow-up US were included. We retrospectively reviewed the US findings for a total of 143 thyroid nodules (123 benign nodules and 20 malignant nodules). The US features that we compared included composition, echogenicity, margin, calcifications, shape, and underlying echogenicity.
In total, thyroid cancer was diagnosed in 20 nodules (14.0%). The size of the nodule was significantly associated with malignancy (P < 0.05). Most of the sonographically probable benign nodules were found to be benign (97.6%). Suspicious nodules on US were thyroid cancer in 43.2% of cases. Marked hypoechogenicity, microlobulated or irregular margin, microcalcifications, and taller-than-wide shape were significant US findings that correlated with malignancy (P < 0.05). The diagnostic performance of ultrasound for initially non-diagnostic thyroid nodules was as follows: sensitivity of 90.0%, specificity of 65.0%, positive predictive value of 29.5%, and negative predictive value of 97.6%.
In terms of management of thyroid nodules with non-diagnostic FNAC cytology, US evaluation is a feasible and useful method for predicting malignancy.
超声（US）引导下细针穿刺抽吸细胞学检查（FNAC）是一种准确、可靠且简单的方法，用于鉴别甲状腺结节是良性还是恶性。然而，甲状腺结节的非诊断性细胞学结果是US引导下FNAC的一个主要局限性。
调查FNAC结果为非诊断性的病例中甲状腺癌的发生率，并根据超声检查结果为最初FNAC非诊断性的甲状腺结节的管理提供建议。
2006年7月至2009年12月，我院对6684例连续患者的10317个甲状腺结节进行了US引导下FNAC。其中，871个甲状腺结节（8.4%）在初次细胞学评估时被诊断为非诊断性，196个接受了第二次或第三次FNAC。27个甲状腺结节（18.9%）接受了手术，同时纳入了116个细胞学确诊为良性且随访超声无明显变化的甲状腺结节。我们回顾性分析了总共143个甲状腺结节（123个良性结节和20个恶性结节）的超声检查结果。我们比较的超声特征包括成分、回声性、边界、钙化、形状和内部回声性。
总共20个结节（14.0%）被诊断为甲状腺癌。结节大小与恶性程度显著相关（P < 0.05）。大多数超声检查可能为良性的结节被发现是良性的（97.6%）。超声检查可疑的结节在43.2%的病例中为甲状腺癌。明显低回声、微叶状或不规则边界、微钙化以及纵横比大于1的形状是与恶性程度相关的显著超声检查结果（P < 0.05）。超声对最初非诊断性甲状腺结节的诊断性能如下：敏感性为90.0%，特异性为65.0%，阳性预测值为29.5%，阴性预测值为97.6%。
对于FNAC细胞学检查为非诊断性的甲状腺结节的管理，超声评估是预测恶性程度的一种可行且有用的方法。
