Chua Jasmine Me, Tang Jonathan Ym, Lim Desmond Sw, Venkatanarasimha Nanda, Chandramohan Sivanathan, Too Chow Wei, Sanamandra Sarat K, Salkade Parag R, Tan Bien Soo, Damodharan Karthikeyan
Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore.
National University Health System, Singapore, Singapore.
Ultrasound. 2019 Feb;27(1):64-68. doi: 10.1177/1742271X18820556. Epub 2019 Jan 9.
In light of the rising rate of incidentally detected subcentimetre thyroid nodules due to improved surveillance and diagnostic imaging, the decision of whether to perform fine needle aspiration cytology is increasingly pertinent. We aim to assess (1) the sampling adequacy of fine needle aspiration cytology, (2) malignancy rate, (3) thyroidectomy rate and (4) diagnostic accuracy of fine needle aspiration cytology. A total of 245 subcentimetre nodules in 220 patients underwent fine needle aspiration cytology between 2011 and 2014. Medical records were reviewed for cytology results, subsequent management and histopathological results in the event the patient underwent thyroidectomy. Sampling adequacy was calculated as the percentage of diagnostic results (Bethesda II-VI). Malignancy rate was defined as the percentage of Bethesda IV-VI diagnoses. Amongst patients with Bethesda IV-VI diagnoses who underwent thyroidectomy, their cytology reports were correlated with post-operative histopathological findings. The sampling adequacy of fine needle aspiration cytology was 77.1%. Malignancy rate (Bethesda IV-VI) was 9.7%. The respective malignancy rates in the < 5 mm nodule group and ≥ 5 mm nodule group were 6.67 and 10.0%. In total, 79.2% (19/24) of the malignant nodules underwent surgical excision. The rest declined surgery and/or were lost to follow-up. Amongst the malignant nodules which were surgically resected, 84.2% (16/19) had definitive malignant histology. Five of these demonstrated multifocal carcinoma and/or extrathyroidal extension of carcinoma on histology. Initial fine needle aspiration cytology and subsequent histopathological diagnoses matched in all cases except for three that had false-positive fine needle aspiration cytology results. Majority of our patients with suspicious cytology results subsequently underwent thyroidectomy, notwithstanding the relatively lower diagnostic accuracy of fine needle aspiration cytology in subcentimetre thyroid nodules.
鉴于因监测和诊断成像技术的改进，偶然发现的亚厘米级甲状腺结节的发生率不断上升，决定是否进行细针穿刺活检变得越来越重要。我们旨在评估：（1）细针穿刺活检的取材充分性；（2）恶性率；（3）甲状腺切除率；（4）细针穿刺活检的诊断准确性。2011年至2014年间，220例患者的245个亚厘米级结节接受了细针穿刺活检。对病历进行回顾，以获取细胞学结果、后续治疗情况以及患者接受甲状腺切除术后的组织病理学结果。取材充分性以诊断结果（贝塞斯达II - VI级）的百分比计算。恶性率定义为贝塞斯达IV - VI级诊断的百分比。在接受甲状腺切除术的贝塞斯达IV - VI级诊断患者中，将其细胞学报告与术后组织病理学结果进行对比。细针穿刺活检的取材充分率为77.1%。恶性率（贝塞斯达IV - VI级）为9.7%。＜5mm结节组和≥5mm结节组各自的恶性率分别为6.67%和10.0%。总共有79.2%（19/24）的恶性结节接受了手术切除。其余患者拒绝手术和/或失访。在接受手术切除的恶性结节中，84.2%（16/19）有明确的恶性组织学诊断。其中5例在组织学上显示为多灶性癌和/或癌的甲状腺外侵犯。除3例假阳性细针穿刺活检结果外，所有病例的初始细针穿刺活检结果与后续组织病理学诊断均相符。尽管细针穿刺活检在亚厘米级甲状腺结节中的诊断准确性相对较低，但大多数细胞学结果可疑的患者随后都接受了甲状腺切除术。
