From the Department of Diagnostic Imaging (T.J.T.A., M.K.A., D.J.G., J.J.C., M.D.B.) and Lifespan Biostatistics Core (G.L.B.), Rhode Island Hospital, 593 Eddy St, Providence, RI 02903.
Radiology. 2014 Sep;272(3):777-84. doi: 10.1148/radiol.14132134. Epub 2014 Apr 17.
To identify demographic and ultrasonographic (US) features associated with malignancy after initially nondiagnostic results of fine-needle aspiration (FNA) to help clarify the role of repeat FNA, surgical excision, or serial US in these nodules.
This study was HIPAA compliant and institutional review board approved; informed consent was waived. Thyroid nodules (n = 5349) that underwent US-guided FNA in 2004-2012 were identified; 393 were single nodules with nondiagnostic FNA results but adequate cytologic, surgical, or US follow-up. Demographic information and diameters and volume at US at first biopsy were modeled with malignancy as outcome through medical record review. Exact logistic regression was used to model malignancy outcomes, demographic comparisons with age were made (Student t test, Satterthwaite test), and proportion confidence intervals (CIs) were estimated (Clopper-Pearson method).
Of 393 nodules with initially nondiagnostic results, nine malignancies (2.3%) were subsequently diagnosed with repeat FNA (n = 2, 0.5%) or surgical pathologic examination (n = 7, 1.8%), 330 (84.0%) were benign, and 54 (13.7%) were stable or decreased in size at serial US (mean follow-up, 3.0 years; median, 2.5 years; range, 1.0-7.8 years). Patients with malignancies were significantly older (mean age, 62.7 years; median, 64 years; range, 47-77 years) than those without (mean age, 55.4 years; median, 57 years; range, 12-94 years; P = .0392). Odds of malignancy were 4.2 times higher for men versus women (P = .045) and increased significantly for each 1-cm increase in anteroposterior, minimum, and mean nodule diameter (1.78, 2.10, and 1.96, respectively). In 393 nodules, no malignancies were detected in cystic or spongiform nodules (both, n = 11, 2.8%; 95% CI: 1.4%, 5.0%), nodules with eggshell calcifications (n = 9, 2.3%; 95% CI: 1.1%, 4.3%), or indeterminate echogenic foci (n = 39, 9.9%; 95% CI: 7.2%, 13.3%).
Very few malignancies were diagnosed with repeat FNA following nondiagnostic FNA results (two of 336, 0.6%); therefore, clinical and US follow-up may be more appropriate than repeat FNA following nondiagnostic biopsy results.
确定最初细针抽吸（FNA）结果为非诊断性后与恶性肿瘤相关的人口统计学和超声（US）特征，以帮助阐明在这些结节中重复 FNA、手术切除或连续 US 的作用。
本研究符合 HIPAA 规定和机构审查委员会批准；豁免了知情同意。确定了 2004 年至 2012 年间接受过 US 引导下 FNA 的甲状腺结节（n = 5349）；393 个为单结节，FNA 结果为非诊断性，但细胞学、手术或 US 随访充分。通过病历回顾，将人口统计学信息和首次活检时的直径和体积建模为恶性肿瘤的结果。使用精确逻辑回归对恶性肿瘤结果进行建模，比较年龄的人口统计学差异（学生 t 检验、Satterthwaite 检验），并估计比例置信区间（Clopper-Pearson 方法）。
在 393 个最初结果为非诊断性的结节中，有 9 个恶性肿瘤（2.3%）随后通过重复 FNA（n = 2，0.5%）或手术病理检查（n = 7，1.8%）诊断，330 个（84.0%）为良性，54 个（13.7%）在连续 US 中稳定或减小（平均随访 3.0 年；中位数 2.5 年；范围 1.0-7.8 年）。恶性肿瘤患者的年龄明显大于（平均年龄 62.7 岁；中位数 64 岁；范围 47-77 岁）而非恶性肿瘤患者（平均年龄 55.4 岁；中位数 57 岁；范围 12-94 岁；P =.0392）。与女性相比，男性发生恶性肿瘤的可能性高 4.2 倍（P =.045），并且随着前后径、最小和平均结节直径每增加 1cm，恶性肿瘤的可能性显著增加（分别为 1.78、2.10 和 1.96）。在 393 个结节中，囊性或海绵状结节（均 n = 11，2.8%；95%CI：1.4%，5.0%）、蛋壳样钙化结节（n = 9，2.3%；95%CI：1.1%，4.3%）或不定型等回声灶（n = 39，9.9%；95%CI：7.2%，13.3%）中均未发现恶性肿瘤。
在非诊断性 FNA 结果后，通过重复 FNA 诊断出的恶性肿瘤很少（336 例中有 2 例，0.6%）；因此，与非诊断性活检结果后重复 FNA 相比，临床和 US 随访可能更合适。
