Jo Vickie Y, Vanderlaan Paul A, Marqusee Ellen, Krane Jeffrey F
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass., USA.
Acta Cytol. 2011;55(6):539-43. doi: 10.1159/000333230. Epub 2011 Dec 9.
Thyroid nodules with nondiagnostic (ND) fine-needle aspirations (FNA) typically undergo repeat sampling. While repeat FNA is often diagnostic, little is known regarding the significance of repeatedly ND aspirates. Limited data suggest there is very low, if any, risk of malignancy for repeatedly ND FNAs.
We performed a retrospective analysis of ND thyroid FNAs over a nearly 6-year period at our institution to further address this question.
There were 834 ND thyroid FNAs, representing 694 distinct thyroid nodules. Repeat FNA was performed after an initial ND aspirate in 52% of cases (363/694); 19% (70/363) had at least one additional ND diagnosis on repeat FNA. Surgical follow-up was available for 57 cases. Malignancy was identified histologically in 21% (9/42) of nodules after a single ND FNA and in 20% (3/15) of nodules with 2 or more repeatedly ND aspirates. Accounting for all benign cytologic follow-up, the overall risk of malignancy was 4% [12/303; 3.5% (9/255) following a single ND FNA and 6.3% (3/48) after repeated ND FNAs].
We observed no modification of malignancy risk when repeated FNAs were ND. Clinical management for an ND aspirate should remain repeat aspiration along with clinical and sonographic correlation.
细针穿刺活检（FNA）结果为非诊断性（ND）的甲状腺结节通常需再次取样。虽然再次FNA往往能明确诊断，但对于多次FNA结果均为ND的意义知之甚少。有限的数据表明，多次FNA结果为ND的情况下，恶性风险即使有也非常低。
我们对本机构近6年的ND甲状腺FNA进行了回顾性分析，以进一步探讨这个问题。
共有834例ND甲状腺FNA，代表694个不同的甲状腺结节。52%（363/694）的病例在首次FNA结果为ND后进行了再次FNA；其中19%（70/363）在再次FNA时至少又有一次ND诊断结果。57例有手术随访结果。在单次FNA结果为ND的结节中，组织学检查发现21%（9/42）为恶性，在2次或更多次FNA结果均为ND的结节中，20%（3/15）为恶性。综合所有良性细胞学随访情况，总体恶性风险为4%[12/303；单次FNA结果为ND后为3.5%（9/255），多次FNA结果为ND后为6.3%（3/48）]。
我们观察到，当再次FNA结果为ND时，恶性风险并无变化。对于FNA结果为ND的情况，临床处理仍应是再次穿刺，并结合临床及超声检查结果。
