Schreiner Andrew M, Yang Grace C H
Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, New York, USA.
Diagn Cytopathol. 2012 May;40(5):375-9. doi: 10.1002/dc.21499. Epub 2010 Nov 2.
According to several large studies, the surgical pathologist renders a non-neoplastic diagnosis in ∼20-40% of thyroid fine-needle aspiration (FNA) cases reported as follicular neoplasm. This study analyzes the cause of this poor correlation between cytology and histology. Cases consisting of oncocytic (Hurthle) cells were excluded from study. During the study period from January 1996 to April 2010, histologic follow-up was available for 234 of 670 cases (34.9%) reported as follicular neoplasm on ultrasound-guided thyroid FNA. Sonographic and Doppler data were available in all cases and included nodule location, size, echogenicity, and vascularity. Of the 234 aspirates with follow-up, surgical pathology reported 130 cases (55.6%) of follicular adenoma, 15 cases (6.4%) of follicular carcinoma, 14 cases (6.1%) of follicular variant of papillary carcinoma, and 75 cases (32.3%) of nodular goiter. Recuts of those index nodules reported as nodular goiter were examined independently by two pathologists using the 2× objective lens. Adenomatoid nodule was defined as an insufficiently encapsulated "blue" nodule of increased nuclear density when compared with the surrounding thyroid. Of the 75 cases reported as nodular goiter, 60 index nodules (80%) fulfilled the described criteria for adenomatoid nodule, while 15 did not. In conclusion, adenomatoid nodules are the main cause of poor histologic correlation with follicular neoplasm reported by FNA. If "increased nuclear density at scanning magnification" were adopted by surgical pathologists as the major diagnostic criterion for follicular adenoma rather than encapsulation, noncorrelated cases would be reduced from 32 to 6.4%.
根据多项大型研究，在报告为滤泡性肿瘤的甲状腺细针穿刺抽吸活检（FNA）病例中，手术病理学家给出非肿瘤性诊断的比例约为20% - 40%。本研究分析了细胞学与组织学之间这种相关性较差的原因。研究排除了由嗜酸性（许特莱）细胞组成的病例。在1996年1月至2010年4月的研究期间，超声引导下甲状腺FNA报告为滤泡性肿瘤的670例病例中，有234例（34.9%）获得了组织学随访结果。所有病例均有超声和多普勒数据，包括结节位置、大小、回声性和血管情况。在234例有随访结果的抽吸物中，手术病理报告130例（55.6%）为滤泡性腺瘤，15例（6.4%）为滤泡性癌，14例（6.1%）为乳头状癌滤泡变体，75例（32.3%）为结节性甲状腺肿。两名病理学家使用2倍物镜独立检查那些报告为结节性甲状腺肿的初始结节的再次切片。腺瘤样结节被定义为与周围甲状腺相比，包膜不足的“蓝色”结节，核密度增加。在报告为结节性甲状腺肿的75例病例中，60个初始结节（80%）符合所述腺瘤样结节标准，而15个不符合。总之，腺瘤样结节是FNA报告的滤泡性肿瘤与组织学相关性较差的主要原因。如果手术病理学家采用“扫描放大倍数下核密度增加”作为滤泡性腺瘤的主要诊断标准而非包膜情况，不相关病例将从32.3%减少至6.4%。
