Partyka Kristen L, Huang Eric C, Cramer Harvey M, Chen Shaoxiong, Wu Howard H
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, California.
Cancer Cytopathol. 2016 Jul;124(7):467-71. doi: 10.1002/cncy.21713. Epub 2016 Mar 11.
Although fine-needle aspiration (FNA) has an important role in evaluating thyroid nodules in adults, there is little published information regarding its utility in the pediatric population.
A retrospective analysis of thyroid FNAs for patients who were 18 years old or younger at 2 institutions was conducted. Aspirates were retrospectively categorized with the Bethesda System for Reporting Thyroid Cytopathology. These diagnoses were then correlated with either final histopathology or clinical follow-up.
A total of 186 thyroid FNA samples from 154 patients (122 females and 32 males), who ranged in age from 9 months to 18 years (median, 16 years; mean, 14 years), were identified. FNA was performed to evaluate 1 to 3 nodules for each patient. Aspirates were classified as follows: nondiagnostic (n = 27), benign (n = 114), atypia of undetermined significance (AUS; n = 21), follicular neoplasm (FN; n = 8), suspicious for malignancy (n = 3), and malignant (n = 13). Sixty-one samples had a histologic correlation, 68 were followed clinically for ≥2 years, and 57 either had no follow-up or were followed for <2 years. For statistical purposes, FNA diagnoses of suspicious and malignant were considered positive, and benign lesions were considered negative. The accuracy was 99%, and the sensitivity and specificity were 94% and 100%, respectively. The risk of malignancy, not including papillary microcarcinoma, was 2% for benign aspirates, 21% for AUS, 57% for FN, and 100% for suspicious or malignant aspirates.
This analysis demonstrates that FNA is a sensitive and highly specific modality for evaluating thyroid nodules in pediatric patients. Each diagnostic category can facilitate communication and guide appropriate management. Cancer Cytopathol 2016;124:467-71. © 2016 American Cancer Society.
尽管细针穿刺抽吸活检（FNA）在评估成人甲状腺结节中具有重要作用，但关于其在儿科人群中的应用，公开信息较少。
对两家机构中18岁及以下患者的甲状腺FNA进行回顾性分析。抽吸物根据甲状腺细胞病理学报告的贝塞斯达系统进行回顾性分类。然后将这些诊断结果与最终组织病理学或临床随访结果进行关联。
共鉴定出154例患者（122例女性和32例男性）的186份甲状腺FNA样本，年龄范围为9个月至18岁（中位数16岁；平均14岁）。对每位患者的1至3个结节进行FNA评估。抽吸物分类如下：无法诊断（n = 27）、良性（n = 114）、意义未明的非典型病变（AUS；n = 21）、滤泡性肿瘤（FN；n = 8）、可疑恶性（n = 3）和恶性（n = 13）。61份样本有组织学相关性，68份进行了≥2年的临床随访，57份未进行随访或随访时间<2年。为了统计目的，将FNA诊断为可疑和恶性的视为阳性，良性病变视为阴性。准确率为99%，敏感性和特异性分别为94%和100%。不包括微小乳头状癌在内，良性抽吸物的恶性风险为2%，AUS为21%，FN为57%，可疑或恶性抽吸物为100%。
该分析表明，FNA是评估儿科患者甲状腺结节的一种敏感且高度特异的方法。每个诊断类别都有助于沟通并指导适当的管理。《癌症细胞病理学》2016年；124:467 - 71。©2016美国癌症协会。
