Takada Nami, Hirokawa Mitsuyoshi, Suzuki Ayana, Higuchi Miyoko, Kuma Seiji, Miyauchi Akira
Department of Laboratory, Kuma Hospital, Kobe, Japan.
Department of Diagnostic Pathology, Kuma Hospital, Kobe, Japan.
Endocr J. 2017 Aug 30;64(8):759-765. doi: 10.1507/endocrj.EJ17-0082. Epub 2017 Jul 13.
According to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), cyst fluid only (CFO) cases are classified in the non-diagnostic category. To date, no large study focusing on CFO has been conducted. To reassess the diagnostic significance of CFO, we compared CFO nodules with non-diagnostic nodules excluding CFO (ND-other). We reviewed the conventional thyroid smears of 715 CFO and 766 ND-other nodules. We compared the timing of and findings at re-aspiration, the histology of resected specimens, and the proportion of malignant nodules between the two groups. Re-aspiration was performed in 9.0% of CFO and 23.8% of ND-other cases. In 12.5% of CFO and 49.4% of ND-other cases, the interval between the first and second aspirations was <3 months. Despite this, there were no cases in which cytological interpretation was complicated by the first aspiration. Overall, 77 CFO nodules (10.8%) were surgically resected; 14 were malignant. In all cases in which re-aspiration cytology revealed malignancy, the initial ultrasound interpretation was a high or intermediate suspicion pattern. The proportion of malignancies subsequently diagnosed in nodules initially classified as CFO and ND-other was 2.0% and 5.6%, respectively (p<0.01). As CFO and ND-other thyroid nodules have different clinical management and malignancy rates, we would like to assert that CFO and ND-other nodules should be separated, and that the former should be considered diagnostic. In terms of clinical management, we recommend that only CFO cases with concerning features on ultrasound undergo re-aspiration.
根据甲状腺细胞病理学报告的贝塞斯达系统（BSRTC），仅含囊液（CFO）的病例被归类为非诊断性类别。迄今为止，尚未开展针对CFO的大型研究。为重新评估CFO的诊断意义，我们将CFO结节与排除CFO的非诊断性结节（ND-其他）进行了比较。我们回顾了715个CFO结节和766个ND-其他结节的传统甲状腺涂片。我们比较了再次穿刺的时间和结果、切除标本的组织学以及两组之间恶性结节的比例。9.0%的CFO病例和23.8%的ND-其他病例进行了再次穿刺。12.5%的CFO病例和49.4%的ND-其他病例中，首次和第二次穿刺的间隔时间<3个月。尽管如此，没有病例因首次穿刺而使细胞学解释变得复杂。总体而言，77个CFO结节（10.8%）接受了手术切除；14个为恶性。在所有再次穿刺细胞学显示为恶性的病例中，最初的超声解释为高度或中度可疑模式。最初分类为CFO和ND-其他的结节中，随后诊断为恶性的比例分别为2.0%和5.6%（p<0.01）。由于CFO和ND-其他甲状腺结节具有不同的临床管理和恶性率，我们主张应将CFO和ND-其他结节分开，并且应将前者视为可诊断的。在临床管理方面，我们建议仅对超声有可疑特征的CFO病例进行再次穿刺。
