De Jong S A, Demeter J G, Castelli M, Jarosz H, Barbato A, Brooks M H, Braithwaite S, Emanuele M A, Lawrence A M, Paloyan E
Department of Surgery, Loyola University Stritch School of Medicine, Maywood, Ill.
Surgery. 1990 Oct;108(4):794-9; discussion 799-800.
The interpretation of aspiration cytologic smears that contain a predominance of follicular components often presents a dilemma to the clinician who is treating a patient who has a dominant thyroid nodule, especially when thyroid-stimulating hormone suppression does not produce any significant involution of the dominant nodule. We reviewed a consecutive series of 555 fine-needle aspiration cytologic examinations of dominant thyroid nodules. All specimens that contained colloid or follicular cells mixed with lymphocytes or Hürthle cells were excluded from this review. Additionally, nine aspirates contained degenerated follicular cells with insufficient material for cytologic diagnosis. The remaining 76 specimens contained a predominance of follicular cells: 27 specimens were interpreted as containing "normal" follicular cells, and the remaining 49 specimens were read as "atypical" follicular cells. Histopathologic examination of the resected specimens indicated a 60% incidence of neoplasia (30% carcinoma, 30% adenoma) in which the aspiration cytologic study was interpreted as "normal" follicular cells. On the other hand, a 63% incidence of neoplasia (27% carcinoma, 36% adenoma) occurred in which the cytologic study was read as "atypical." In conclusion, aspirates showing a predominance of follicular cells, whether "normal" or "atypical" indicate a 60% incidence of neoplasia in dominant thyroid nodules that do not decrease significantly in size with thyroid-stimulating hormone suppression.
对于含有大量滤泡成分的细针穿刺细胞学涂片的解读，常常给治疗甲状腺优势结节患者的临床医生带来两难困境，尤其是当促甲状腺激素抑制治疗未使优势结节出现任何明显缩小的时候。我们回顾了连续555例甲状腺优势结节的细针穿刺细胞学检查。所有含有胶质或滤泡细胞并混有淋巴细胞或许特莱细胞的标本均被排除在本回顾研究之外。此外，有9份穿刺样本含有退化的滤泡细胞，因材料不足无法进行细胞学诊断。其余76份标本以滤泡细胞为主：27份标本被解读为含有“正常”滤泡细胞，其余49份标本被解读为“非典型”滤泡细胞。对切除标本的组织病理学检查显示，在穿刺细胞学检查被解读为“正常”滤泡细胞的病例中，肿瘤发生率为60%（30%为癌，30%为腺瘤）。另一方面，在细胞学检查被解读为“非典型”的病例中，肿瘤发生率为63%（27%为癌，36%为腺瘤）。总之，以滤泡细胞为主的穿刺样本，无论“正常”还是“非典型”，都表明在甲状腺优势结节中，肿瘤发生率为60%，且这些结节在促甲状腺激素抑制治疗后大小无明显减小。
