Renshaw Andrew A, Gould Ewing W
Department of Pathology, Baptist Hospital and Miami Cancer Institute, Miami, Florida.
Cancer Cytopathol. 2017 Nov;125(11):848-853. doi: 10.1002/cncy.21904. Epub 2017 Jul 31.
Recommendations regarding how many nodules to biopsy with thyroid fine-needle aspiration vary.
The authors reviewed fine-needle aspiration specimens of 12,763 nodules from 10,506 patients and correlated them with the number of nodules biopsied.
Compared with patients in whom only a single nodule was biopsied, patients in whom multiple nodules were biopsied were found to be significantly younger, more likely female, and to have larger tumors, and those tumors were more often papillary (all P<.001). On fine-needle aspiration, patients who had multiple nodules biopsied were more often diagnosed with benign findings (P<.001), but usually had no significant difference in the risk of malignancy associated with any cytologic diagnosis. Performing biopsy in 3 nodules detected all carcinomas in the current series. Combining all cases in the literature demonstrated that performing only 3 biopsies in a patient with at least 4 suspicious nodules had a risk of malignancy of 1.2%.
Biopsy of 3 different nodules in patients with multiple nodules appears to lower the risk of malignancy to that of a benign fine-needle aspiration specimen. Although exceptions can occur, cytologists may be able to improve the accuracy of their diagnoses by focusing predominantly on identifying papillary carcinoma after the first 2 nodules have been biopsied. Cancer Cytopathol 2017;125:848-53. © 2017 American Cancer Society.
关于甲状腺细针穿刺活检应取多少个结节的建议各不相同。
作者回顾了10506例患者的12763个结节的细针穿刺标本，并将其与活检的结节数量相关联。
与仅对单个结节进行活检的患者相比，对多个结节进行活检的患者明显更年轻，更可能为女性，肿瘤更大，且这些肿瘤更常为乳头状（所有P<0.001）。在细针穿刺方面，对多个结节进行活检的患者更常被诊断为良性结果（P<0.001），但通常在任何细胞学诊断相关的恶性风险方面无显著差异。对3个结节进行活检可检测出本系列中的所有癌症。综合文献中的所有病例表明，对至少有4个可疑结节的患者仅进行3次活检，其恶性风险为1.2%。
对多个结节的患者进行3个不同结节的活检似乎可将恶性风险降低至良性细针穿刺标本的水平。尽管可能会有例外情况，但细胞学家在对前2个结节进行活检后，可主要专注于识别乳头状癌，从而提高诊断的准确性。《癌症细胞病理学》2017年；125：848 - 53。©2017美国癌症协会。
