Aydoğan Berna İmge, Şahin Mustafa, Ceyhan Koray, Deniz Olgun, Demir Özgür, Emral Rifat, Tonyukuk Gedik Vedia, Uysal Ali Rıza, Çorapçıoğlu Demet
Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey.
Department of Cytology, Ankara University Faculty of Medicine, Ankara, Turkey.
Diagn Cytopathol. 2019 Jul;47(7):682-687. doi: 10.1002/dc.24170. Epub 2019 Mar 12.
Diagnostic accuracy of fine-needle aspiration cytology (FNAC) in large and subcentimeter nodules is still debated. We aimed to evaluate the impact of nodule size on efficacy of the ultrasound-guided FNAC.
B-mode grayscale ultrasound (US), US-guided FNAC according to Bethesda system and histopathological data of 514 nodules from 371 patients, who underwent thyroidectomy were examined retrospectively. Nodules were grouped by maximal diameter; group A nodules were smaller than 10 mm (n = 59), group B nodules were between 10 and 29 mm (n = 218), and group C nodules were 30 mm or greater (n = 130).
Sensitivity, specificity, and accuracy of FNAC was 92.0%, 100%, and 95.1% in group A, 80.7%, 99.1%, and %92.9 in group B, 70.0%, 98.9%, and 95.8% in group C nodules, respectively. The prevalence of papillary thyroid cancer (PTC) and incidental PTC were 44.2% (n = 164) and 6.4% (n = 24), respectively. Malignancy rate was more frequent in group A when compared to groups B and C (P < 0.01). Nodule size was positively associated with follicular cancer risk (P = 0.009). The thyroid stimulating hormone level was positively associated with malignancy (P = 0.02) and optimal cut-off value was 0.96 mIU/L. False-negative rate was 8.0%, 19.3%, and 30.0% in groups A, B, and C nodules, respectively.
Although the malignancy rate was low in nodules ≥30 mm, diagnostic surgery for large nodules should be considered because of decreased reliability of FNAC, ineffectiveness of clinical and sonographic criteria. False-negative rate was relatively low and malignancy rate was high in subcentimeter nodules, supporting the accuracy of FNAC.
细针穿刺细胞学检查（FNAC）在大结节和小于1厘米结节中的诊断准确性仍存在争议。我们旨在评估结节大小对超声引导下FNAC疗效的影响。
回顾性检查371例行甲状腺切除术患者的514个结节的B型灰阶超声（US）、根据贝塞斯达系统进行的超声引导下FNAC及组织病理学数据。结节按最大直径分组；A组结节小于10毫米（n = 59），B组结节直径在10至29毫米之间（n = 218），C组结节为30毫米或更大（n = 130）。
A组FNAC的敏感性、特异性和准确性分别为92.0%、100%和95.1%，B组分别为80.7%、99.1%和92.9%，C组结节分别为70.0%、98.9%和95.8%。甲状腺乳头状癌（PTC）的患病率和偶然PTC分别为44.2%（n = 164）和6.4%（n = 24）。与B组和C组相比，A组的恶性率更高（P < 0.01）。结节大小与滤泡癌风险呈正相关（P = 0.009）。促甲状腺激素水平与恶性肿瘤呈正相关（P = 0.02），最佳临界值为0.96 mIU/L。A、B、C组结节的假阴性率分别为8.0%、19.3%和30.0%。
尽管直径≥30毫米的结节恶性率较低，但由于FNAC可靠性降低、临床和超声标准无效，应考虑对大结节进行诊断性手术。小于1厘米的结节假阴性率相对较低，恶性率较高，支持FNAC的准确性。
