Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Cancer Cytopathol. 2020 Jan;128(1):68-75. doi: 10.1002/cncy.22213. Epub 2019 Nov 21.
Hürthle cell metaplasia is common in hyperplastic nodules, particularly within the setting of lymphocytic thyroiditis (LT). The Bethesda System for Reporting Thyroid Cytopathology indicates that it is acceptable to classify Hürthle cell-predominant fine-needle aspiration (HC FNA) specimens as atypia of undetermined significance (AUS) rather than suspicious for a Hürthle cell neoplasm (HUR) within the setting of multiple nodules or known LT. The goal of the current study was to address whether this approach is justified.
HC FNA specimens were identified and correlated with ultrasound and surgical pathology reports if available. Multinodularity was determined based on findings on macroscopic examination if imaging results were unavailable.
A total of 698 HC FNA specimens were identified, including 576 resected nodules, 455 of which (79%) were benign. The overall risk of malignancy for HUR was 27%, whereas the risk of malignancy for AUS was 10%. The mean size of the benign nodules was 2.1 cm on surgical resection specimens, with multiple nodules noted in 293 cases (64%) and histologic LT noted in 116 cases (25%). The mean size of the malignant nodules was 2.8 cm, with multiple nodules and histologic LT noted in 74 cases (61%) and 22 cases (18%), respectively. The malignancy rate did not differ between solitary or multiple nodules (P = .52) or in the presence or absence of LT (P = .12). However, size did significantly differ between malignant and benign nodules (P < 0.01).
The malignancy rate did not differ significantly in the presence of multiple nodules or LT, although the latter demonstrated a statistical trend. A diagnosis of AUS over HUR based solely on the presence of multinodularity is not warranted.
Hurthle 细胞化生在增生性结节中很常见，特别是在淋巴细胞性甲状腺炎（LT）中。甲状腺细胞病理学报告的 Bethesda 系统指出，在多个结节或已知 LT 的情况下，将 Hurthle 细胞占优势的细针抽吸（HC FNA）标本归类为意义未确定的不典型（AUS）而不是 Hurthle 细胞肿瘤（HUR）是可以接受的。本研究的目的是探讨这种方法是否合理。
确定 HC FNA 标本，并在有条件的情况下与超声和手术病理报告相关联。如果没有影像学结果，则根据大体检查结果确定多结节性。
共鉴定出 698 例 HC FNA 标本，包括 576 例切除结节，其中 455 例（79%）为良性。HUR 的总体恶性肿瘤风险为 27%，而 AUS 的恶性肿瘤风险为 10%。良性结节的平均大小为手术切除标本的 2.1cm，293 例（64%）有多个结节，116 例（25%）有组织学 LT。恶性结节的平均大小为 2.8cm，74 例（61%）和 22 例（18%）分别有多个结节和组织学 LT。孤立或多个结节之间的恶性率无差异（P=0.52），LT 的存在与否也无差异（P=0.12）。然而，恶性和良性结节之间的大小确实存在显著差异（P<0.01）。
多个结节或 LT 的存在并不显著影响恶性率，尽管后者存在统计学趋势。仅基于多结节性就将 AUS 诊断为 HUR 是没有依据的。
