重复细针穿刺在甲状腺结节性质不确定的处理中的作用
The role of repeat fine needle aspiration in the management of indeterminate thyroid nodules.
作者信息
Jooya Alborz, Saliba Joe, Blackburn Audrey, Tamilia Michael, Hier Michael P, Mlynarek Alex, Forest Véronique-Isabelle, Rochon Louise, Florea Anca, Wang Hangjun, Payne Richard J
机构信息
Department of Otolaryngology - Head and Neck Surgery - Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Room E-903, Montréal, H3T 1E2, QC, Canada.
Division of Endocrinology, Jewish General Hospital - McGill University, Montreal, QC, Canada.
出版信息
J Otolaryngol Head Neck Surg. 2016 Oct 18;45(1):51. doi: 10.1186/s40463-016-0164-0.
BACKGROUND
Management decisions are not straightforward when the Ultrasound Guided Fine Needle Aspiration (USFNA) demonstrates a Bethesda score of either category III or IV, and a diagnostic hemi-thyroidectomy or a repeat USFNA (r-USFNA) could be performed. The aim of this study is to assess the effectiveness of r-USFNA in the management of indeterminate thyroid nodules by evaluating the likelihood of obtaining a definite diagnosis.
METHODS
We reviewed the medical records of all patients with thyroid nodules between 2011 and 2015 at the Jewish General Hospital (Montreal, Canada). Three hundred fifty-one patients who had undergone a surgical procedure (hemi or total thyroidectomy) and a diagnosis of B3 or B4 on the primary USFNA (p-USFNA) were included in the study. Ninety-six of the included patients also had a repeat USFNA prior to the surgery. Demographic data, type of procedure, and McGill Thyroid Nodule Score (MTNS) were obtained from the medical records. Malignancy rates were calculated based on the final surgical histopathology report.
RESULTS
Upon r-USFNA, an average 76 % of patients did not change Bethesda categories, 7.4 % downgraded to a benign category. The results showed that, on an average 17.3 % of patients with p-USFNA of B3 and 20 % of patients with p-USFNA of B4, upgraded to a malignant or suspicious for malignancy category, thus changing the clinical management to total thyroidectomy. Our data demonstrates that r-USFNA facilitates choosing the correct surgery of total thyroidectomy in about 20 % of nodules that have upgraded from B3/B4 to a more definite malignant category.
CONCLUSIONS
r-USFNA in patients with indeterminate diagnoses (B3 or B4) increases categorization into more definite categories. Approximately 20 % of patients are found to have malignant thyroid nodules and suspicious for malignancy thyroid nodules upon repeating the biopsy, hence a diagnostic hemi-thyroidectomy was avoided and a more definitive surgery could be performed. Furthermore, repeat USFNA results in a fewer number of hemi-thyroidectomy and completion thyroidectomy procedures.
背景
当超声引导下细针穿刺活检（USFNA）显示为贝塞斯达分类系统III类或IV类时，管理决策并不简单，此时可以进行诊断性半甲状腺切除术或重复USFNA（r-USFNA）。本研究的目的是通过评估获得明确诊断的可能性，来评估r-USFNA在处理甲状腺结节诊断不明确中的有效性。
方法
我们回顾了2011年至2015年加拿大蒙特利尔犹太总医院所有甲状腺结节患者的病历。纳入研究的患者有351例，这些患者均接受了手术治疗（半甲状腺或全甲状腺切除术），且初次USFNA（p-USFNA）诊断为B3或B4。其中96例患者在手术前还进行了重复USFNA。从病历中获取人口统计学数据、手术类型和麦吉尔甲状腺结节评分（MTNS）。根据最终手术病理报告计算恶性率。
结果
r-USFNA后，平均76%的患者贝塞斯达分类没有改变，7.4%降级为良性类别。结果显示，p-USFNA为B3的患者平均有17.3%、p-USFNA为B4的患者平均有20%升级为恶性或可疑恶性类别，从而将临床管理改为全甲状腺切除术。我们的数据表明，r-USFNA有助于在约20%从B3/B4升级为更明确恶性类别的结节中选择正确的全甲状腺切除术。
结论
对诊断不明确（B3或B4）的患者进行r-USFNA可增加分类为更明确类别的比例。重复活检后，约20%的患者被发现患有恶性甲状腺结节和可疑恶性甲状腺结节，从而避免了诊断性半甲状腺切除术，可进行更明确的手术。此外，重复USFNA减少了半甲状腺切除术和甲状腺全切术的手术数量。
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