Chakravarthy N Siddhartha, Chandramohan Anuradha, Prabhu Anne Jennifer, Gowri M, Mannam Pavithra, Shyamkumar N K, Naik Dukhabandhu, Cherian A J, Thomas Nihal, Paul M J, Abraham Deepak
Department of Endocrine Surgery, Christian Medical College (CMC), Vellore, Tamil Nadu, India.
Department of Radiology, Christian Medical College (CMC), Vellore, Tamil Nadu, India.
Indian J Endocrinol Metab. 2018 Sep-Oct;22(5):597-604. doi: 10.4103/ijem.IJEM_1_18.
The aim of the study is to examine the adequacy and accuracy of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in thyroid nodules ≥1 cm and to analyze the clinical, sonological, and cytological features in predicting thyroid malignancy.
US-FNAC was done on 290 patients from December 2013 to December 2014 by the radiologist. The Thyroid Imaging Reporting and Data System (TIRADS) was used to record the sonological features. FNAC samples were reported by a dedicated cytopathologist. Accuracy was calculated by comparing US-FNAC, clinical features and ultrasound (US) features for those who had final histopathology till April 2017.
The adequacy of US-FNAC in this study was 80.2%. Thyroidectomy was performed in 128/290 (44.1%). The sensitivity and specificity of US-FNAC in this study is 83.9 and 76.3%, respectively, with a positive predictive value of 85.2%, negative predictive value of 74.4%, and an accuracy of 81% in predicting malignancy in thyroid nodules ≥1 cm. The malignancy rate in benign FNAC sample was 25% (10/40), and was 69% (8/13) in those with a follicular lesion of undetermined significance (FLUS). Around 80% of benign and 89% of FLUS had follicular variant of papillary carcinoma of thyroid (FVPTC). US-FNAC, a high TIRADS score, and US features such as marked hypoechogenicity, taller than wide, irregular margins, microcalcification, and clinical features, such as hard in consistency and significant cervical lymph nodes, were important in predicting malignancy ( < 0.001).
The accuracy of US-FNAC in this study is 81%. The US-FNAC, a high TIRADS score, a hard thyroid nodule, and significant cervical lymph nodes are important in predicting malignancy. The accuracy rate in benign and atypia undetermined significance categories needs to improve in this study. Further research to help in decreasing false negative rates of FVPTC will help in increasing the accuracy of US-FNAC in the present study.
本研究旨在检验超声引导下细针穿刺细胞学检查（US-FNAC）在直径≥1 cm甲状腺结节中的充分性和准确性，并分析预测甲状腺恶性肿瘤的临床、超声及细胞学特征。
2013年12月至2014年12月，放射科医生对290例患者进行了US-FNAC检查。采用甲状腺影像报告和数据系统（TIRADS）记录超声特征。细针穿刺抽吸样本由专门的细胞病理学家报告。通过比较US-FNAC、临床特征及超声（US）特征与截至2017年4月已行最终组织病理学检查患者的结果，计算准确性。
本研究中US-FNAC的充分率为80.2%。290例患者中有128例（44.1%）接受了甲状腺切除术。本研究中US-FNAC预测直径≥1 cm甲状腺结节恶性肿瘤的敏感性和特异性分别为83.9%和76.3%，阳性预测值为85.2%，阴性预测值为74.4%，准确性为81%。良性细针穿刺抽吸样本中的恶性率为25%（10/40），意义不明确的滤泡性病变（FLUS）患者中的恶性率为69%（8/13）。约80%的良性及89%的FLUS病例存在甲状腺乳头状癌滤泡亚型（FVPTC）。US-FNAC、高TIRADS评分以及超声特征如显著低回声、纵横比大于1、边界不规则、微钙化，以及临床特征如质地硬和显著的颈部淋巴结，对预测恶性肿瘤具有重要意义（<0.001）。
本研究中US-FNAC的准确性为81%。US-FNAC、高TIRADS评分、质地硬的甲状腺结节及显著的颈部淋巴结对预测恶性肿瘤具有重要意义。本研究中良性及意义不明确的非典型性类别中的准确率有待提高。进一步研究以降低FVPTC的假阴性率将有助于提高本研究中US-FNAC的准确性。
