在经细针穿刺诊断为可疑恶性或恶性的患者中，细针穿刺与冰冻切片在评估甲状腺恶性结节中的应用比较

Fine-Needle Aspiration Versus Frozen Section in the Evaluation of Malignant Thyroid Nodules in Patients With the Diagnosis of Suspicious for Malignancy or Malignancy by Fine-Needle Aspiration.

作者信息

Ye Qin, Woo Jennifer S, Zhao Qunzi, Wang Ping, Huang Pintong, Chen Lirong, Li Xin, Xu Kanlun, Yong Ying, Sung-Eun Yang Stephanie, Rao Jianyu

机构信息

From the Departments of Pathology (Drs Ye, Chen, and Xu, and Ms Li), Surgery (Drs Zhao and Wang), and Ultrasonography (Dr Huang), Second Affiliate Hospital, Zhejiang University, Hangzhou, China; and the Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs Woo, Yang, and Rao, and Mr Yong).

出版信息

Arch Pathol Lab Med. 2017 May;141(5):684-689. doi: 10.5858/arpa.2016-0305-OA.

DOI:10.5858/arpa.2016-0305-OA

PMID:28447904

Abstract

CONTEXT

The Bethesda System for Reporting Thyroid Cytopathology recommends against the use of intraoperative frozen section (FS) during lobectomy of a thyroid nodule with a fine-needle aspiration (FNA) diagnosis of malignant. Bethesda recommendations for FS in the FNA category of suspicious for malignancy (SFM) is less well-defined. In some institutions in China, FS examination is performed during lobectomy even for FNA-proven malignant cases.

OBJECTIVE

-To compare the efficacy of FNA versus FS in the evaluation of malignant thyroid lesions.

DESIGN

A 3-year retrospective analysis from a single institution was performed on cases with an FNA diagnosis of SFM or malignant with subsequent FS examination during thyroidectomy. The results of FNA and FS findings were compared to the final thyroidectomy pathology.

RESULTS

-A total of 5832 thyroidectomy procedures were performed: 1265 cases had FNA and FS results available. Fine-needle aspiration gave a diagnosis of SFM to 306 cases and a diagnosis of malignant to 821 cases. Of the SFM cases, 10.5% (32 of 306) had benign/indeterminate, 4.6% (14 of 306) suspicious, and 84.9% (260 of 306) malignant FS results. Final pathology showed 56.3% (18 of 32), 64.3% (9 of 14), and 100% (260 of 260) malignancy rates, respectively. For the malignant FNA group, 10.0% (82 of 821) had benign/indeterminate, 4.4% (36 of 821) suspicious, and 85.6% (703 of 821) malignant FS results. The final pathology showed 96.4% (79 of 82), 97.2% (35 of 36), and 99.9% (702 of 703) malignancy rates, respectively.

CONCLUSIONS

Frozen section should not be performed for the malignant FNA category because FS evaluation may result in 10% falsely negative findings. Performing FS for SFM may be better justified; however, more than half of FS cases read as benign in this category had malignant final pathology. Therefore, caution should be taken for FS results even in the SFM group.

摘要

背景

甲状腺细胞病理学报告的贝塞斯达系统建议，对于细针穿刺活检（FNA）诊断为恶性的甲状腺结节行叶切除术时，不建议使用术中冰冻切片（FS）。贝塞斯达系统对于FNA分类为恶性可疑（SFM）的FS建议尚不够明确。在中国的一些机构中，即使对于FNA确诊为恶性的病例，在叶切除术中也会进行FS检查。

目的

比较FNA与FS在评估甲状腺恶性病变中的效能。

设计

对一家机构3年的病例进行回顾性分析，这些病例FNA诊断为SFM或恶性，随后在甲状腺切除术中进行了FS检查。将FNA和FS检查结果与最终甲状腺切除术后病理结果进行比较。

结果

共进行了5832例甲状腺切除术：1265例有FNA和FS结果。FNA诊断为SFM的有306例，诊断为恶性的有821例。在SFM病例中，FS结果为良性/不确定的占10.5%（306例中的32例），可疑的占4.6%（306例中的14例），恶性的占84.9%（306例中的260例）。最终病理显示恶性率分别为56.3%（32例中的18例）、64.3%（14例中的9例）和100%（260例中的260例）。对于FNA诊断为恶性的组，FS结果为良性/不确定的占10.0%（821例中的82例），可疑的占4.4%（821例中的36例），恶性的占85.6%（821例中的703例）。最终病理显示恶性率分别为96.4%（82例中的79例）、97.2%（36例中的35例）和99.9%（703例中的702例）。