Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University, College of Medicine, 1435 Jwa-dong, Haeundae-gu, Busan 612-030, Republic of Korea.
Int J Surg. 2013;11(9):898-902. doi: 10.1016/j.ijsu.2013.07.010. Epub 2013 Jul 31.
Our aim was to evaluate predictive factors of malignancy in patients with cytologically suspicious for Hurthle cell neoplasm (HCN) of thyroid nodules.
We searched cases with cytologically suspicious for HCN from 11,569 ultrasound-guided fine-needle aspirations (US-FNA) performed at our institution. Nodules that were confirmed surgically or followed-up for at least 2 years were compared with respect to age, gender, tumor size, US diagnosis, and US findings to predict malignancy.
The incidence of cases with cytologically suspicious for HCN was 1.2% (143 of 11,569). Of 75 nodules that underwent sufficient follow-up or surgery, malignancies were found in 11 (14.7%). Malignant histological examination revealed oncocytic variants of papillary thyroid carcinoma (PTC) in 3 cases, classic PTC in 1, Hurthle cell carcinoma in 3, follicular carcinoma in 3 and an unclassified carcinoma in 1. In univariate analysis, tumor size was significantly larger in malignant nodules compared to benign nodules (p = 0.026). The best cut-off value of tumor size in predicting malignancy was 2.5 cm. (p = 0.006, sensitivity: 63.6%, specificity: 79.7%). The incidences of hypoechogenicity and malignant US diagnoses were higher in malignant nodules than in benign nodules (p < 0.001). In multivariate analysis, tumor size was an independent factor in predicting malignancies. (p = 0.037, odd ratio: 2.09, confidence interval: 1.046-4.161).
Preoperative US provides predictive factors of malignancy in thyroid nodules with cytologically suspicious for HCN. Predictive factors include tumor size of 2.5 cm or greater, hypoechoic nodule and malignant US diagnosis.
本研究旨在评估甲状腺细胞学可疑 Hurthle 细胞肿瘤（HCN）结节患者的恶性肿瘤预测因素。
我们从本机构进行的 11569 例超声引导下细针抽吸（US-FNA）中检索出细胞学可疑 HCN 的病例。对经手术证实或至少随访 2 年的结节，比较其年龄、性别、肿瘤大小、US 诊断和 US 表现，以预测恶性肿瘤的发生。
细胞学可疑 HCN 的病例发生率为 1.2%（143/11569）。在 75 例进行了充分随访或手术的结节中，发现恶性肿瘤 11 例（14.7%）。恶性组织学检查显示 3 例为甲状腺乳头状癌（PTC）的嗜酸细胞型，1 例为经典型 PTC，3 例为 Hurthle 细胞癌，3 例为滤泡癌，1 例为未分类癌。单因素分析显示，恶性结节的肿瘤大小明显大于良性结节（p=0.026）。预测恶性肿瘤的最佳肿瘤大小截断值为 2.5cm（p=0.006，敏感性：63.6%，特异性：79.7%）。恶性结节的低回声和恶性 US 诊断的发生率均高于良性结节（p<0.001）。多因素分析显示，肿瘤大小是预测恶性肿瘤的独立因素（p=0.037，优势比：2.09，95%置信区间：1.046-4.161）。
术前 US 为甲状腺细胞学可疑 HCN 结节的恶性肿瘤提供了预测因素。预测因素包括肿瘤大小为 2.5cm 或以上、低回声结节和恶性 US 诊断。
