Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas, KS 66160.
Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas, KS 66160.
Ann Diagn Pathol. 2014 Jun;18(3):177-80. doi: 10.1016/j.anndiagpath.2014.03.003. Epub 2014 Mar 29.
After thyroidectomy for primary thyroid malignancies, patients are closely monitored for recurrence or metastasis. Fine needle aspiration (FNA) has been used as the appropriate diagnostic modality for occult masses identified radiographically in the thyroid bed. In this study, we report our institutional experience with FNA of the thyroid bed and propose practical diagnostic categories. A retrospective chart review of all thyroid bed FNAs between April 2008 and January 2013 was performed, and a cohort of 39 patients was retrieved. The cytology diagnoses were divided into 5 categories including nondiagnostic, inflammatory/reactive, bland follicular cells, suspicious for neoplasm/malignancy, and malignant. The follow-up histologic and/or clinical findings were collected for each category. The 39 patients included 9 males and 30 females (ages 15-79 years). Prior thyroidectomies were due to papillary thyroid carcinoma (31 cases), follicular carcinoma (3 cases), medullary carcinoma (1 case), Hürthle cell carcinoma (1 case), malignancy unspecified (1 case), follicular adenoma (1 case), and multinodular goiter (1 case). Overall, 33% (13 cases) of thyroid bed FNAs were nondiagnostic, and 10% (4 cases) were categorized as "inflammatory/reactive." None of the patients in these 2 categories demonstrated evidence of clinical recurrence. One patient with a "bland follicular cells" thyroid bed FNA diagnosis had metastatic papillary thyroid carcinoma on follow-up histology. Of 14 patients in the "suspicious" and "malignant" categories, 10 had malignant follow-up diagnosis on histology. In conclusion, thyroid bed FNA with standardized diagnostic categories is a useful modality for follow-up in patients who have undergone thyroidectomy.
甲状腺癌患者行甲状腺切除术治疗后，需要密切监测疾病复发或转移情况。细针穿刺抽吸（FNA）已被用于诊断甲状腺床内放射性隐匿性肿块。本研究报告了我们采用 FNA 诊断甲状腺床的经验，并提出了实用的诊断类别。我们对 2008 年 4 月至 2013 年 1 月间所有甲状腺床 FNA 进行了回顾性图表分析，共获取 39 例患者。细胞学诊断分为 5 类：无法诊断、炎症/反应性、滤泡细胞良性、可疑肿瘤/恶性、恶性。每一类都收集了随访的组织学和/或临床发现。39 例患者中，男 9 例，女 30 例（年龄 15-79 岁）。既往甲状腺切除术的病因分别为：甲状腺乳头状癌（31 例）、滤泡状癌（3 例）、甲状腺髓样癌（1 例）、Hurthle 细胞癌（1 例）、恶性肿瘤不明（1 例）、滤泡性腺瘤（1 例）和结节性甲状腺肿（1 例）。总体而言，33%（13 例）的甲状腺床 FNA 无法诊断，10%（4 例）为“炎症/反应性”。这 2 类患者均无临床复发证据。1 例“良性滤泡细胞”甲状腺床 FNA 患者，随访组织学检查为甲状腺乳头状癌转移。在“可疑”和“恶性”的 14 例患者中，10 例经组织学检查发现恶性肿瘤。总之，采用标准化诊断类别的甲状腺床 FNA 是甲状腺切除术后患者随访的一种有用方法。
