Khan Tayyab S, Sharma Esha, Singh Baldev, Jammu Bikram, Chadha Amarinder, Markanday Divya, Wu Yan Yan, Bajaj Harpreet S
Division of Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada.
LMC Diabetes and Endocrinology, Brampton, Ontario, Canada.
Eur Thyroid J. 2018 Jun;7(3):129-132. doi: 10.1159/000488451. Epub 2018 May 16.
The link between the diagnostic yield of thyroid fine-needle aspiration and biopsy (FNAB) in patients taking antithrombotic or anticoagulant medications (AT/AC) remains poorly characterized.
We studied the risk of obtaining a nondiagnostic sample with ultrasound-guided thyroid FNAB in patients taking AT/AC medications.
This is a retrospective cohort study using medical rec-ords of 556 patients who underwent thyroid FNAB. All cytology samples were reported using the Bethesda classification. For patients with a nondiagnostic cytology, logistic regression was used to calculate OR for patients taking AT/AC medications. Multivariate regression was used to adjust for potential confounding variables including age, cystic ultrasound features, presence of eggshell calcifications, number of passes performed, cystic aspirate on FNAB, and position of the nodule.
Out of 556 patients, cytology results were available for 547 patients. Of these, 46 subjects were taking aspirin and 1 was on warfarin. Among the entire cohort, 17.5% of the subjects had a nondiagnostic cytology. Among the patients on AT/AC medications, 34% had a nondiagnostic result compared to 16% for those not taking them (OR = 2.70, = 0.003). The subgroup of patients taking aspirin had similarly higher odds of a nondiagnostic cytology (OR = 2.78, = 0.002). These differences remained statistically significant after multivariate adjustment.
This is the first study to demonstrate a 3-fold independently greater risk of a nondiagnostic FNAB cytology in patients taking aspirin. Our results highlight the importance of evaluating the need for continuation of aspirin in patients undergoing thyroid FNAB as this may impact the diagnostic yield of the procedure.
在服用抗血栓或抗凝药物（AT/AC）的患者中，甲状腺细针穿刺抽吸活检（FNAB）的诊断率之间的联系仍未得到充分描述。
我们研究了在服用AT/AC药物的患者中，超声引导下甲状腺FNAB获取非诊断性样本的风险。
这是一项回顾性队列研究，使用了556例行甲状腺FNAB患者的医疗记录。所有细胞学样本均按照贝塞斯达分类法报告。对于细胞学诊断不明确的患者，采用逻辑回归计算服用AT/AC药物患者的比值比（OR）。采用多变量回归调整潜在的混杂变量，包括年龄、超声囊性特征、蛋壳样钙化的存在、穿刺次数、FNAB时的囊性抽吸物以及结节位置。
556例患者中，547例有细胞学结果。其中，46例服用阿司匹林，1例服用华法林。在整个队列中，17.5%的受试者细胞学诊断不明确。在服用AT/AC药物的患者中，34%的结果为非诊断性，而未服用者为16%（OR = 2.70，P = 0.003）。服用阿司匹林的患者亚组中，非诊断性细胞学的几率同样较高（OR = 2.78，P = 0.002）。多变量调整后，这些差异仍具有统计学意义。
这是第一项证明服用阿司匹林的患者FNAB细胞学非诊断性风险独立增加3倍的研究。我们的结果强调了在接受甲状腺FNAB的患者中评估继续服用阿司匹林必要性的重要性，因为这可能会影响该操作的诊断率。
