Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California.
Department of Head and Neck Surgery, University of California, Los Angeles.
JAMA Otolaryngol Head Neck Surg. 2014 Jan;140(1):52-7. doi: 10.1001/jamaoto.2013.5650.
Although infarction after fine-needle aspiration (FNA) is a rare occurrence, it is a known phenomenon that may lead to difficulties in interpretation for pathologists and in decision-making for head and neck surgeons.
To characterize our experience with infarction in papillary thyroid carcinomas (PTCs) after FNA and review existing cases of infarcted PTCs in the literature to better understand this phenomenon.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective case series and review of literature at a tertiary medical center (University of California, Los Angeles [UCLA], Medical Center). All patients who had a surgical pathologic diagnosis of infarcted PTC and who underwent FNA prior to surgery at UCLA from June 2006 to June 2012 were identified. There were 620 cases of PTC and 12 cases of infarcted PTC.
Demographic data, FNA cytologic findings, and surgical pathologic data were gathered for each patient. A comprehensive literature search for infarcted PTC was performed.
Twelve cases of infarcted PTC were found in a total of 620 cases of PTC (1.9%). The mean (SD) time interval between the last FNA and surgery was 52 (35) days (range, 13-133 days). All patients received a diagnosis of infarcted PTC after thyroidectomy was performed. Focal infarction was found in 4 patients (33%), and near-total infarction was found in 8 patients (67%). Five patients (47%) had the follicular variant of PTC, making it the most common subtype in our series. A thorough literature search yielded 11 articles reporting a total of 26 cases of infarcted PTC after FNA. To our knowledge, our case series on infarcted PTC is the largest reported series in the literature.
Although infarction of PTC after FNA occurs infrequently, it may lead to difficulties in histologic diagnosis. Awareness of this phenomenon and its histologic associations, along with careful reevaluation of the FNA and surgical specimens, is important for appropriate diagnosis and subsequent treatment. At this point, infarction in PTC should not alarm a head and neck surgeon to change management, but future prospective studies with a large population of patients with infarcted PTCs are needed to establish the impact of infarction on differences in treatment outcomes for therapies that may be used in PTCs.
虽然细针穿刺抽吸（FNA）后梗死是一种罕见的现象，但它是一种已知的现象，可能导致病理学家在解释和头颈部外科医生在决策方面存在困难。
描述我们在 FNA 后甲状腺乳头状癌（PTC）中梗死的经验，并回顾文献中现有的梗死性 PTC 病例，以更好地了解这一现象。
设计、地点和参与者：这是一项在三级医疗中心（加利福尼亚大学洛杉矶分校[UCLA]医疗中心）进行的回顾性病例系列和文献复习。确定了 2006 年 6 月至 2012 年 6 月期间在 UCLA 接受手术病理诊断为梗死性 PTC 并在手术前接受 FNA 的所有患者。共有 620 例 PTC 和 12 例梗死性 PTC。
收集了每位患者的人口统计学数据、FNA 细胞学发现和手术病理数据。对梗死性 PTC 进行了全面的文献检索。
在总共 620 例 PTC 中发现了 12 例梗死性 PTC（1.9%）。最后一次 FNA 与手术之间的平均（SD）时间间隔为 52（35）天（范围，13-133 天）。所有患者在进行甲状腺切除术时均被诊断为梗死性 PTC。4 例（33%）发现局灶性梗死，8 例（67%）发现近全梗死。5 例（47%）为 PTC 的滤泡变体，使其成为我们系列中最常见的亚型。全面的文献检索发现了 11 篇报道 FNA 后 26 例梗死性 PTC 的文章。据我们所知，我们关于梗死性 PTC 的病例系列是文献中报道的最大系列。
尽管 FNA 后 PTC 梗死很少见，但它可能导致组织学诊断困难。认识到这一现象及其组织学关联，并仔细重新评估 FNA 和手术标本，对于适当的诊断和随后的治疗非常重要。目前，PTC 梗死不应引起头颈部外科医生改变治疗方法，但需要对大量梗死性 PTC 患者进行前瞻性研究，以确定梗死对 PTC 可能使用的治疗方法在治疗结果上的差异的影响。
