Partyka Kristen L, Wu Howard H
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
J Am Soc Cytopathol. 2017 Nov-Dec;6(6):236-241. doi: 10.1016/j.jasc.2017.06.006. Epub 2017 Jun 29.
Widespread use of ultrasound allows for detection of smaller thyroid nodules and preoperative evaluation with fine-needle aspiration (FNA). Both incidental and non-incidental microcarcinoma can be found, leading to uncertainty with clinical management.
A retrospective analysis of thyroid FNAs performed at our institution was conducted for the 5-year period from 2010 to 2014. Aspirates were categorized using the Bethesda System for Reporting Thyroid Cytopathology. Cytologic diagnoses were then correlated with final histopathology. Among samples with malignancy on surgical resection, nodules were stratified by size.
A total of 2531 thyroid FNAs were identified; 587 samples had histologic correlation, and 259 malignancies were reported. They were separated into nodules >1 cm (n = 144, 56%) and ≤1 cm (n = 115, 44%). Microcarcinoma was further subdivided into incidental (size ≤0.5 cm, n = 55, 48%) and non-incidental (size >0.5 cm and ≤1 cm, n = 60, 52%). The preoperative cytologic diagnoses for incidental microcarcinoma were: benign (B, n = 11, 20%), follicular lesion of undetermined significance (FLUS, n = 15, 27%), follicular neoplasm (FN, n = 11, 20%), suspicious for malignancy (SM, n = 7, 13%), malignant (M, n = 8, 15%), and nondiagnostic (ND, n = 3, 5%). The FNA categories for non-incidental microcarcinoma were: B (n = 13, 22%), FLUS (n = 3, 5%), FN (n = 3, 5%), SM (n = 10, 17%), M (n = 29, 48%), and ND (n = 2, 3%).
Incidental microcarcinoma is not an uncommon entity, making up 21% (55 of 259) of malignant nodules on thyroidectomy. Indeterminate diagnoses (FLUS + FN + SM) accounted for the majority (60%) of preoperative FNAs for incidental microcarcinoma, compared with 27% for those of non-incidental microcarcinoma (P < 0.05, χ test).
超声的广泛应用使得能够检测到更小的甲状腺结节，并通过细针穿刺抽吸（FNA）进行术前评估。偶然发现和非偶然发现的微小癌均可能被检测到，这导致临床管理存在不确定性。
对2010年至2014年在我们机构进行的甲状腺FNA进行了为期5年的回顾性分析。穿刺样本根据甲状腺细胞病理学报告的贝塞斯达系统进行分类。然后将细胞学诊断结果与最终的组织病理学结果进行关联。在手术切除的恶性样本中，结节按大小分层。
共识别出2531例甲状腺FNA；587个样本有组织学关联，报告了259例恶性肿瘤。它们被分为直径>1 cm的结节（n = 144，56%）和直径≤1 cm的结节（n = 115，44%）。微小癌进一步细分为偶然发现的（直径≤0.5 cm，n = 55，48%）和非偶然发现的（直径>0.5 cm且≤1 cm，n = 60，52%）。偶然发现的微小癌术前细胞学诊断为：良性（B，n = 11，20%）、意义不明确的滤泡性病变（FLUS，n = 15，27%）、滤泡性肿瘤（FN，n = 11，20%）、可疑恶性（SM，n = 7，13%）、恶性（M，n = 8，15%）和无法诊断（ND，n = 3，5%）。非偶然发现的微小癌的FNA分类为：B（n = 13，22%）、FLUS（n = 3，5%）、FN（n = 3，5%）、SM（n = 10，17%）、M（n = 29，48%）和ND（n = 2，3%）。
偶然发现的微小癌并非罕见实体，占甲状腺切除术中恶性结节的21%（259例中的55例）。不确定诊断（FLUS + FN + SM）占偶然发现的微小癌术前FNA的大多数（60%），而非偶然发现的微小癌为27%（P < 0.05，χ检验）。
