Janković Snezana Kuzmić, Andjelković Zoran, Cerović Snezana, Milosavljević Ivica
Vojnomedicinska akademija, Klinika za endokrinologiju, Beograd, Srbija.
Vojnosanit Pregl. 2011 Aug;68(8):669-75. doi: 10.2298/vsp1108669k.
BACKGRAUND/AIM: Conventional cytomorphology of thyroid cell aspirates is limited in preoperative differential diagnosis of follicular adenomas (FA) and hyperplastic adenomatoid nodular goiters from well differentiated thyroid follicular carcinoma (FTC) and follicular variant of thyroid papillary carcinoma (PTC). This is the reason of inaccurate presurgical differential diagnosis and in the same cases of inadequate operative managament. The aim of the study was to evaluate the role of quantitative estimation of thyreocite nuclear features (cariomorphometry) in thyroid aspirated smears in preoperative differential diagnosis of benign from malignant thyroid lesions.
A total of 48 patients with thyroid nodular disease underwent fine needle aspiration biopsy for cytomorphology, cariomorphometric analysis of the aspirates, and histopathologic explorations conducted fully postoperatively. On the basis of cytomorphology classification the patients were divided into three groups: benign (B), n = 8; malignant (M), n = 15, and suspicious for malignancy (S), n = 25. Using a microscope connected to a computerized video system, mean nuclear area, the nuclear area coefficient of variation (NACV) and anisocariosis ratio were measured and calculated.
In all the 15 patients with cytologically malignant results the diagnosis of PTC was confirmed histopathologically. All cytologically benign lesions were confirmed histopathologically. Thyroid carcinoma was found in 15 out of 25 patients with suspicious lesions. The highest mean values of nuclear area were in the PCT (90.74 +/- 26.71 microm2), and were significantly different from all other groups (p < 0.001). The mean nuclear area in FTC was 69.20 +/- 27.31 microm2 and was significantly higher than in the benign adenomatous group (p < 0.01). There was no significant difference in mean nuclear area between FTC and FA, but there was a significant difference in NACV between these two groups (FTC: 39.46% vs FA: 23.42%,p < 0.001). In 27 out of 30 patients with thyroid carcinoma higher values of NACV than 18% were found.
Preoperatively cariomorphometry is a useful method in differential diagnosis of thyroid carcinoma from benign lesions, as a complementary method to convencional cytodiagnostics. The NACV showed highest sensitivity as a parameter of malignant thyroid cell transformation.
背景/目的：甲状腺细胞穿刺物的传统细胞形态学在术前鉴别诊断滤泡性腺瘤（FA）、增生性腺瘤样结节性甲状腺肿与高分化甲状腺滤泡癌（FTC）及甲状腺乳头状癌滤泡变体（PTC）方面存在局限性。这就是术前鉴别诊断不准确以及在相同病例中手术管理不足的原因。本研究的目的是评估甲状腺穿刺涂片中印戒细胞形态特征定量评估（核形态计量学）在甲状腺良恶性病变术前鉴别诊断中的作用。
共有48例甲状腺结节性疾病患者接受了细针穿刺活检以进行细胞形态学检查、穿刺物的核形态计量学分析以及术后全面的组织病理学检查。根据细胞形态学分类，将患者分为三组：良性（B）组，n = 8；恶性（M）组，n = 15，以及可疑恶性（S）组，n = 25。使用连接到计算机视频系统的显微镜测量并计算平均核面积、核面积变异系数（NACV）和核异形率。
在所有15例细胞学检查结果为恶性的患者中，组织病理学确诊为PTC。所有细胞学检查为良性的病变均经组织病理学证实。在25例可疑病变患者中，有15例发现甲状腺癌。核面积的最高平均值见于PTC组（90.74 ± 26.71平方微米），且与所有其他组有显著差异（p < 0.001）。FTC组的平均核面积为69.20 ± 27.31平方微米，显著高于良性腺瘤组（p < 0.01）。FTC与FA之间的平均核面积无显著差异，但这两组之间的NACV有显著差异（FTC：39.46% 对FA：23.42%，p < 0.001）。在30例甲状腺癌患者中，有27例的NACV值高于18%。
术前核形态计量学是甲状腺癌与良性病变鉴别诊断中的一种有用方法，可作为传统细胞诊断的补充方法。NACV作为甲状腺癌细胞转化的参数显示出最高的敏感性。
