具有意义不明确的非典型性或意义不明确的滤泡性病变的甲状腺结节亚类中恶性风险差异及管理建议：超声引导下粗针穿刺活检的作用

Differences in risk of malignancy and management recommendations in subcategories of thyroid nodules with atypia of undetermined significance or follicular lesion of undetermined significance: the role of ultrasound-guided core-needle biopsy.

作者信息

Choi Young Jun, Baek Jung Hwan, Ha Eun Ju, Lim Hyun Kyung, Lee Jeong Hyun, Kim Jae Kyun, Song Dong Eun, Shong Young Kee, Hong Suck Joon

机构信息

1 Department of Radiology, University of Ulsan College of Medicine , Seoul, South Korea .

出版信息

Thyroid. 2014 Mar;24(3):494-501. doi: 10.1089/thy.2012.0635. Epub 2014 Jan 15.

DOI:10.1089/thy.2012.0635

PMID:23947771

Abstract

BACKGROUND

The cytopathologic description of atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) includes nine different criteria in The Bethesda System, and the risk of malignancy in this category shows a wide range. The objectives of the present study were to determine whether ultrasound (US)-guided core-needle biopsy (CNB) indicates a different malignant risk, and to identify management recommendations, malignant US findings, and distribution of CNB readings in subcategories of AUS/FLUS category, as seen on previous thyroid fine-needle aspiration readings.

METHODS

From October 2008 to July 2011, 191 thyroid nodules of 191 patients who had previously been diagnosed with nuclear atypia (Group AUS; n=84) and microfollicular architecture (Group FLUS; n=107) were enrolled in our retrospective study. Final diagnoses were obtained in 142 nodules after surgery and clinico-radiological follow-up. We compared the malignancy risk, management recommendation, malignant US findings, and distribution of CNB readings between the two groups and calculated the diagnostic value of CNB.

RESULTS

With CNB, the final malignancy results were greater in Group AUS (65%, 33/51) than Group FLUS (14.3%, 13/91; p<0.001), and there were more surgical candidates in Group AUS (57.8%, 46/84) than Group FLUS (19.6%, 21/107; p<0.001). CNB showed 95.8% diagnostic accuracy for identifying malignancies and 19.4% inconclusive readings. Malignant US findings were seen more frequently in Group AUS (76.5%, 39/51) than Group FLUS (52.7%, 48/91; p=0.007). Malignant CNB readings were statistically more frequent in Group AUS (49.2%, 41/84) than Group FLUS (9.4%, 10/107; p<0.001), and benign readings were statistically more frequent in Group FLUS (58.9%, 63/107) than Group AUS (28.6%, 24/84; p<0.001).

CONCLUSIONS

US-guided CNB demonstrated that Group AUS showed a higher risk of malignancy, of becoming surgical candidates, of having malignant US findings, and of having malignant CNB readings than Group FLUS. Further management guidelines for Group AUS should differ from Group FLUS.

摘要

背景

在《贝塞斯达系统》中，意义不明确的非典型性（AUS）/意义不明确的滤泡性病变（FLUS）的细胞病理学描述包括九种不同标准，此类病变的恶性风险范围较广。本研究的目的是确定超声（US）引导下的粗针穿刺活检（CNB）是否显示出不同的恶性风险，并确定管理建议、US恶性表现以及AUS/FLUS类别亚组中CNB读数的分布情况，这些情况如先前甲状腺细针穿刺活检读数所示。

方法

2008年10月至2011年7月，对191例先前被诊断为核非典型性（AUS组；n = 84）和微滤泡结构（FLUS组；n = 107）的患者的191个甲状腺结节进行了回顾性研究。术后及临床放射学随访后，对142个结节获得了最终诊断。我们比较了两组之间的恶性风险、管理建议、US恶性表现以及CNB读数的分布，并计算了CNB的诊断价值。

结果

通过CNB，AUS组的最终恶性结果（65%，33/51）高于FLUS组（14.3%，13/91；p<0.001），AUS组的手术候选者（57.8%，46/84）多于FLUS组（19.6%，21/107；p<0.001）。CNB对识别恶性肿瘤的诊断准确率为95.8%，不确定读数为19.4%。AUS组的US恶性表现（76.5%，39/51）比FLUS组（52.7%，48/91；p = 0.007）更常见。AUS组的恶性CNB读数（49.2%，41/84）在统计学上比FLUS组（9.4%，10/107；p<0.001）更频繁，FLUS组的良性读数（58.9%，63/107）在统计学上比AUS组（28.6%，24/84；p<0.001）更频繁。