Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Cancer Cytopathol. 2018 Aug;126(8):518-524. doi: 10.1002/cncy.22015. Epub 2018 May 7.
The American Thyroid Association (ATA) recommends fine-needle aspiration (FNA) biopsy of nodules measuring >1.5 cm with low-suspicion sonographic patterns or >1.0 cm with high/intermediate-suspicion features. Routine biopsy of nodules <1 cm is not recommended. However, despite these recommendations, subcentimeter nodules are often referred for FNA biopsy.
This was a retrospective chart review of consecutive thyroid FNAs during an 18-month period (1157 patients, 1491 nodules, 2016-2017) to evaluate age, sex, medical history, diagnoses, and follow-up. Radiographic information was used to identify 61 subcentimeter nodules (4%) from 57 patients. Ultrasound studies were re-evaluated using criteria according to the American College of Radiology Thyroid Imaging, Reporting, and Data System (TI-RADS).
Reported reasons for biopsy included a larger companion nodule (44%), a personal or family history of cancer (26%), or a suspicious sonogram, including calcification and/or irregular contours (16%). FNA diagnoses included: 69% benign (42 of 61 nodules), 10% papillary thyroid carcinoma (PTC) (6 of 61 nodules), and 15% atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) (9 of 61 nodules). Seven percent of nodules were unsatisfactory/nondiagnostic (4 of 61 nodules) compared with a 3% nondiagnostic rate for all sized nodules. Fifty-one nodules had an ultrasound available for re-review using the TI-RADS scoring system. A high TI-RADS score (4-5) was indicative of PTC in 29.4% of nodules. A low TI-RADS score (1-2) was indicative of PTC in 0% of nodules (P < .01). High and intermediate TI-RADS scores (3 and 4-5, respectively) were indicative of PTC/AUS/FLUS in 32% of nodules compared with 0% in those with low TI-RADS scores (P < .01).
The current results demonstrate successful use of the TI-RADS scoring system in evaluation of the risk of malignancy in subcentimeter nodules. Larger studies will be necessary to determine whether biopsy is warranted for TI-RADS high-subcentimeter nodules. Cancer Cytopathol 2018. © 2018 American Cancer Society.
美国甲状腺协会（ATA）建议对直径>1.5 厘米且超声表现低度可疑或直径>1.0 厘米且高度/中度可疑的结节进行细针抽吸活检（FNA）。不建议对直径<1 厘米的结节进行常规活检。然而，尽管有这些建议，直径小于 1 厘米的结节仍经常被推荐进行 FNA 活检。
这是一项回顾性图表分析，对 18 个月期间（2016 年至 2017 年）连续进行的甲状腺 FNA 进行了评估，评估了年龄、性别、病史、诊断和随访情况。影像学信息用于从 57 名患者中识别出 61 个直径小于 1 厘米的结节（4%）。使用美国放射学院甲状腺成像、报告和数据系统（TI-RADS）的标准重新评估超声研究。
活检的报告原因包括较大的伴发结节（44%）、个人或家族癌症史（26%）或可疑的超声表现，包括钙化和/或不规则轮廓（16%）。FNA 诊断包括：69%为良性（61 个结节中的 42 个），10%为甲状腺乳头状癌（PTC）（61 个结节中的 6 个），15%为意义未明的非典型性/滤泡性病变（AUS/FLUS）（61 个结节中的 9 个）。与所有大小结节的 3%非诊断率相比，7%的结节不满意/无法诊断（61 个结节中的 4 个）。51 个结节有超声可供使用 TI-RADS 评分系统重新评估。高 TI-RADS 评分（4-5）提示 PTC 占结节的 29.4%。低 TI-RADS 评分（1-2）提示 PTC 占结节的 0%（P<.01）。高 TI-RADS 评分（3）和中 TI-RADS 评分（4-5）分别提示 PTC/AUS/FLUS 占结节的 32%，而低 TI-RADS 评分（1-2）提示 PTC 占结节的 0%（P<.01）。
目前的结果表明，TI-RADS 评分系统可成功用于评估亚厘米结节的恶性肿瘤风险。需要更大的研究来确定 TI-RADS 高亚厘米结节是否需要活检。癌症细胞病理学 2018。© 2018 美国癌症协会。
