甲状腺结节大小对恶性风险和细针抽吸准确性的影响：单中心 10 年研究。

The impact of thyroid nodule size on the risk of malignancy and accuracy of fine-needle aspiration: a 10-year study from a single institution.

机构信息

Department of Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland 20889, USA.

出版信息

Thyroid. 2012 Dec;22(12):1251-6. doi: 10.1089/thy.2012.0265. Epub 2012 Oct 19.

DOI:10.1089/thy.2012.0265

PMID:22962940

Abstract

BACKGROUND

False-negative rates for thyroid fine-needle aspiration (FNA) vary from 0.4% to 13%, but the effect of nodule size on the accuracy of thyroid FNA remains controversial. We hypothesized that large thyroid nodule size does not contribute to the risk of malignancy or the risk of a false-negative FNA.

METHODS

All thyroid FNAs performed at the Walter Reed Army Medical Center during September 2001-August 2011 were reviewed. A strict correlation between the biopsy site, location, and size of nodule on ultrasound (US) and pathology report was ensured. FNA results were classified as benign, atypical, follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), suspicious for malignancy (SM), or malignant, and the pathology result was categorized as either benign or malignant. Nodules were analyzed by size: 0.5-0.9 cm (group A), 1.0-3.9 cm (group B), and ≥ 4 cm (group C). Incidental thyroid cancer was not included.

RESULTS

Of 3013 patients undergoing FNA, 667 (22.1%) had surgery. Patients were excluded for nodules <0.5 cm, nondiagnostic FNA, or no preoperative US, leaving 540 patients with 695 nodules. Among patients referred for surgery, FNA results were benign in 417 nodules (60%), atypical in 22 (3.2%), FN/SFN in 122 (17.6%), SM in 77 (11.1%), and malignant in 57 (8.2%). Postoperative malignancy rates by FNA result were 7% if benign, 4.5% if atypical, 23% if FN/SFN, 33.8% if SM, and 78.9% if malignant. FNA accuracy was 60% in group A, 68.5% in group B, and 80.3% in group C (p=0.01). False-negative rates for FNA were 7.0% overall, 15.8% in group A, 6.3% in group B, and 7.1% in group C (p=0.25). Sensitivity and negative predictive value were highest in group B at 81.6% and 93.7%, respectively. The prevalence of malignancy was not different between groups.

CONCLUSION

Our results show that the thyroid nodule size ≥ 4 cm increases neither the risk of false-negative FNA results, nor the overall risk of malignancy. We also show a tendency toward a higher false-negative rate in subcentimeter nodules. We conclude that a large nodule size should not prompt automatic referral for thyroidectomy. An increased awareness of potential sampling error in subcentimeter nodules is warranted.

摘要

背景

甲状腺细针抽吸（FNA）的假阴性率为 0.4%至 13%，但结节大小对甲状腺 FNA 准确性的影响仍存在争议。我们假设大的甲状腺结节大小不会增加恶性肿瘤的风险或假阴性 FNA 的风险。

方法

回顾 2001 年 9 月至 2011 年 8 月期间在 Walter Reed 陆军医疗中心进行的所有甲状腺 FNA。确保活检部位、超声（US）上结节的位置和大小以及病理报告之间存在严格的相关性。FNA 结果分为良性、非典型、滤泡性肿瘤/滤泡性肿瘤可疑（FN/SFN）、可疑恶性（SM）和恶性，并将病理结果分为良性或恶性。结节按大小分析：0.5-0.9cm（A 组）、1.0-3.9cm（B 组）和≥4cm（C 组）。不包括偶然发现的甲状腺癌。

结果

在 3013 名接受 FNA 的患者中，有 667 名（22.1%）接受了手术。排除结节<0.5cm、非诊断性 FNA 或无术前 US 的患者，留下 540 名患者的 695 个结节。在接受手术转诊的患者中，FNA 结果为良性的有 417 个结节（60%）、非典型的有 22 个结节（3.2%）、FN/SFN 的有 122 个结节（17.6%）、SM 的有 77 个结节（11.1%）和恶性的有 57 个结节（8.2%）。FNA 结果为良性的术后恶性率为 7%，非典型的为 4.5%，FN/SFN 的为 23%，SM 的为 33.8%，恶性的为 78.9%。A 组 FNA 准确率为 60%，B 组为 68.5%，C 组为 80.3%（p=0.01）。FNA 的假阴性率总体为 7.0%，A 组为 15.8%，B 组为 6.3%，C 组为 7.1%（p=0.25）。B 组的敏感性和阴性预测值最高，分别为 81.6%和 93.7%。各组之间的恶性肿瘤发生率无差异。