Dedhia Priya H, Rubio Gustavo A, Cohen Mark S, Miller Barbra S, Gauger Paul G, Hughes David T
Department of Surgery, University of Michigan, 1500 E. Medical Center Drive, 2207 Taubman Center, SPC 5342, Ann Arbor, MI, 48109-5331, USA,
World J Surg. 2014 Mar;38(3):634-8. doi: 10.1007/s00268-013-2430-x.
Increasing utilization of genetic expression profiling (GEP) for thyroid nodules with indeterminate fine needle aspiration (FNA) results will potentially decrease the number of patients requiring diagnostic thyroidectomy. This study sought to determine the potential effects of GEP for indeterminate thyroid FNA results on thyroidectomy volume.
A retrospective review of thyroidectomy procedures performed over 1 year at the University of Michigan in the endocrine surgery division evaluated the indications for thyroidectomy, FNA Bethesda classification, and final surgical pathology to determine how application of GEP on indeterminate FNA results would affect decision for surgery and subsequent thyroidectomy volume.
During the study period, 358 thyroidectomies were performed. The indication for procedure included: FNA findings, n = 122; symptomatic multinodular goiter, n = 85; nodule >4 cm, n = 30; Graves', n = 26; other, n = 95. FNA was performed in 231 patients. Bethesda classification included: benign, n = 69; malignant, n = 55; follicular lesion of undetermined significance, n = 59; follicular neoplasm, n = 20; suspicious for malignancy, n = 16; nondiagnostic, n = 12. If standard GEP was performed for all indeterminate FNA results, it would have influenced the decision for surgery in 68 (19 %) patients. Assuming 38 % of indeterminate FNA specimens will have benign results on genetic profiling, 27 patients would not have undergone thyroidectomy, translating into a 7.2 % decrease in overall thyroidectomy volume over a year.
In an academic endocrine surgery program, the most common indication for thyroidectomy is an FNA result; however, standard application of GEP for all indeterminate thyroid FNAs would result in a minimal reduction in overall thyroidectomy volume.
对于细针穿刺（FNA）结果不确定的甲状腺结节，基因表达谱分析（GEP）应用的增加可能会减少需要进行诊断性甲状腺切除术的患者数量。本研究旨在确定GEP对甲状腺FNA不确定结果的应用对甲状腺切除量的潜在影响。
对密歇根大学内分泌外科在1年多时间内进行的甲状腺切除手术进行回顾性分析，评估甲状腺切除的指征、FNA贝塞斯达分类以及最终手术病理，以确定GEP应用于FNA不确定结果如何影响手术决策及后续甲状腺切除量。
在研究期间，共进行了358例甲状腺切除术。手术指征包括：FNA结果，n = 122；有症状的多结节性甲状腺肿，n = 85；结节>4 cm，n = 30；格雷夫斯病，n = 26；其他，n = 95。231例患者进行了FNA。贝塞斯达分类包括：良性，n = 69；恶性，n = 55；意义未明的滤泡性病变，n = 59；滤泡性腺瘤，n = 20；可疑恶性，n = 16；无法诊断，n = 12。如果对所有FNA不确定结果都进行标准GEP检测，将影响68例（19%）患者的手术决策。假设38%的FNA不确定标本基因检测结果为良性，27例患者将不会接受甲状腺切除术，这意味着一年中甲状腺切除总量将减少7.2%。
在一个学术性内分泌外科项目中，甲状腺切除最常见的指征是FNA结果；然而，对所有甲状腺FNA不确定结果都进行标准GEP检测，只会使甲状腺切除总量略有减少。
