Section of Endocrinology and Metabolic Diseases, Internal Medicine, Umberto I Hospital, ASP 8 SIRACUSA, Siracusa, Italy.
J Endocrinol Invest. 2013 Nov;36(10):843-7. doi: 10.3275/8958. Epub 2013 May 6.
Fine needle cytology aspirates (FNA) classified as THY4 are a heterogeneous group suspicious for malignancy [papillary thyroid cancer (PTC)], which is confirmed in 50-80% of cases after surgery.
To better stratify THY4 FNA specimens for the relative risk of malignancy.
We retrospectively analyzed 78 thyroid nodules classified as THY4 because of the presence of atypical cells, hypercellular trabeculae and/or intranuclear inclusions (ICI), in the absence of papillae. Two subgroups were identified: group 1 (38 nodules), showing ICI with (no.=17) or without (no.=21) trabeculae and cellular atypia, and group 2 (40 nodules), showing trabeculae and atypia but without ICI.
PTC was detected at histology in 56/78 of the patients (71.8%). Malignancy occurred in 36/38 (94.7%) of the patients in group 1 and in 20/40 (50.0%) of the patients in group 2. Therefore, the positive predictive value (PPV) for PTC was 97.3% in the ICI+ specimens (group 1), with a sensitivity of 64.3% and specificity of 95.2%. When only ICI was present, without atypia and trabeculae, the PPV and specificity were similar (95.0 and 95.2%, respectively), but the sensitivity was decreased (48.7%). In specimens without ICI (group 2), the PPV was only 50.0%; however, combined with young age (<40 yr) and male gender, it reached a value similar to that of group1.
In ICI+ specimens compared to ICI-, the risk of PTC is nearly doubled, since PPV increases from 50.0% to 97.3%. This observation suggests that surgery should be considered mandatory in all lesions classified THY4 at FNA, although the relevant difference in terms of cancer risk between ICI- vs ICI+ nodules might be an useful information for both the clinician and the patient.
细针穿刺细胞学（FNA）诊断为 THY4 是一组具有恶性肿瘤可疑特征的异质性群体[甲状腺乳头状癌（PTC）]，其中 50-80%的病例在手术后得到证实。
为了更好地对 THY4 FNA 标本进行恶性肿瘤相对风险分层。
我们回顾性分析了 78 例因存在不典型细胞、细胞丰富的小梁和/或核内包涵体（ICI）而被归类为 THY4 的甲状腺结节，这些结节没有乳头。将这些标本分为两组：第 1 组（38 个结节），显示有 ICI 伴有（n=17）或不伴有（n=21）小梁和细胞异型性，第 2 组（40 个结节），显示小梁和异型性但无 ICI。
78 例患者中有 56 例（71.8%）在组织学上发现 PTC。第 1 组中 36/38（94.7%）的患者和第 2 组中 20/40（50.0%）的患者发生恶性肿瘤。因此，第 1 组中 ICI+标本的 PTC 阳性预测值（PPV）为 97.3%，其敏感性为 64.3%，特异性为 95.2%。当仅存在 ICI，没有异型性和小梁时，PPV 和特异性相似（分别为 95.0%和 95.2%），但敏感性降低（48.7%）。在没有 ICI 的标本（第 2 组）中，PPV 仅为 50.0%；然而，结合年龄<40 岁和男性性别，其值与第 1 组相似。
与 ICI-相比，在 ICI+标本中，PTC 的风险几乎增加了一倍，因为 PPV 从 50.0%增加到 97.3%。这一观察结果表明，尽管 ICI-与 ICI+结节之间的癌症风险差异可能对临床医生和患者都有帮助，但对于所有在 FNA 中被归类为 THY4 的病变，都应考虑进行手术。
