Hamburger J I
Department of Surgery, Sinai Hospital of Detroit, MI 48235.
Thyroidology. 1988 Apr(1):21-34.
Needle biopsy is the most cost-effective and reliable method for selecting thyroid nodules for observation or excision. Fine needle biopsy (FNB) is the preferred method because of safety and simplicity. FNB samples should be taken circumferentially at the periphery of the nodule to avoid the common central degeneration. The following criteria for adequate sampling reduce the potential for false negative diagnoses: e.g. a minimum of 6 aspirates, and at least 6 clusters of benign cells on each of at least 2 of the aspirates, and no malignant cells. A small rate of false positive errors is unavoidable if cancers are not to be overlooked. Study of published didactic and illustrative material permits trained and motivated cytopathologists to develop skills in FNB diagnosis quickly. FNB data may be accurate enough to supplant frozen section data for surgical planning. Patients with FNB diagnoses of benign should be followed, usually with thyroxine therapy. Nodules that do not regress after treatment for one year should be biopsied again, and observation may be safely continued if consistently benign findings are obtained. More reliable FNB diagnoses on cellular and Hurthle cell adenomas would be desirable, but it is unlikely that this will be possible in the near future.
针吸活检是选择甲状腺结节进行观察或切除的最具成本效益且可靠的方法。细针穿刺活检（FNB）因其安全性和简便性而成为首选方法。FNB样本应在结节周边圆周方向采集，以避免常见的中央变性。以下足够采样的标准可降低假阴性诊断的可能性：例如，至少6次抽吸，且至少2次抽吸中的每次都至少有6簇良性细胞，且无恶性细胞。如果不遗漏癌症，小比例的假阳性错误是不可避免的。对已发表的教学和说明性材料的研究使训练有素且积极性高的细胞病理学家能够快速培养FNB诊断技能。FNB数据可能足够准确，足以取代用于手术规划的冰冻切片数据。FNB诊断为良性的患者应进行随访，通常采用甲状腺素治疗。治疗一年后未消退的结节应再次活检，如果获得一致的良性结果，则可安全地继续观察。对于细胞性和许特耳细胞腺瘤，更可靠的FNB诊断是可取的，但近期内不太可能实现。
