Ahn Soon-Hyun, Park So-Yeon, Choi Sang Il
Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University College of Medicine, Bundang Hospital, 300 Goomi-dong, Bundang-gu, Gyeonggi-do, 463-707, South Korea.
Department of Pathology, Seoul National University College of Medicine, Bundang Hospital, Gyeonggi-Do, South Korea.
Endocr Pathol. 2017 Dec;28(4):332-338. doi: 10.1007/s12022-017-9496-1.
There are papers suggesting the complementary role of core needle biopsy (CNB) in the diagnosis of thyroid nodules. By comparing the result of CNB and fine needle aspiration (FNA) cytology performed in consecutive cases of thyroid nodules, the role of CNB was evaluated. Retrospective reviews of 2131 FNA and 275 CNB which were performed as first-line biopsy for 2406 thyroid nodules in 2187 patients were performed. The ultrasound (US) feature of thyroid nodule was classified following the risk of malignancy suggested by American Thyroid Association (ATA) guideline. Rate of unsatisfactory and cellular atypia could be decreased significantly by first-line CNB in all US group, and the nodules with highly suspicious feature showed significant decrease in inconclusive result by first-line CNB. However, increased rates of architectural and follicular neoplasm (FN) were identified in CNB group especially in intermediate and low suspicious nodules, and the first-line CNB could not decrease the inconclusive result in these US groups. The diagnostic rate of neoplasm diagnosed by surgery following the result of architectural atypia or FN was not different between FNA and CNB even with significantly higher rate in CNB group. Furthermore, the sensitivity for follicular neoplasm (21.2 vs. 61.9%) was significantly higher in CNB group. The CNB can be considered in nodules with highly suspicious feature with advantage of significantly lower inconclusive diagnostic rate than FNA group. However, significantly increased diagnosis of architectural atypia or FN in other nodules by CNB is recognized and should be evaluated in future to understand the meaning.
有论文提出粗针穿刺活检（CNB）在甲状腺结节诊断中的辅助作用。通过比较连续甲状腺结节病例中CNB和细针穿刺抽吸（FNA）细胞学检查的结果，对CNB的作用进行了评估。对2187例患者的2406个甲状腺结节进行的2131次FNA和275次CNB作为一线活检进行了回顾性分析。根据美国甲状腺协会（ATA）指南建议的恶性风险对甲状腺结节的超声（US）特征进行分类。在所有US组中，一线CNB可显著降低不满意率和细胞异型率，具有高度可疑特征的结节经一线CNB后不确定结果显著减少。然而，在CNB组中发现结构和滤泡性肿瘤（FN）的发生率增加，尤其是在中度和低度可疑结节中，一线CNB在这些US组中并不能降低不确定结果。即使CNB组的发生率显著更高，但根据结构异型或FN结果通过手术诊断的肿瘤诊断率在FNA和CNB之间并无差异。此外，CNB组对滤泡性肿瘤的敏感性（21.2%对61.9%）显著更高。对于具有高度可疑特征的结节可考虑采用CNB，其优势是不确定诊断率比FNA组显著更低。然而，应认识到CNB在其他结节中显著增加了结构异型或FN的诊断，未来应进行评估以了解其意义。
