Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Endocrinol (Oxf). 2020 May;92(5):468-474. doi: 10.1111/cen.14167. Epub 2020 Feb 25.
We evaluated the preoperative diagnostic values of ultrasound (US), fine-needle aspiration (FNA) and core needle biopsy (CNB) leading to surgery in patients with FTC.
From October 1994 to July 2016, 298 patients with FTC who had preoperative US images and underwent US-guided FNA or CNB and surgery were included in this study. We evaluated the results of preoperative FNA or CNB based on the Bethesda system and the US findings according to the Korean thyroid imaging reporting and data system (K-TIRADS).
Predominant US features of FTC showed solid, hypo- or iso-echogenicity, oval smooth margin and halo with no calcification. Based on K-TIRADS, 140 (47.0%) patients with FTC were categorized as low suspicion, 133 (44.63%) as intermediate suspicion and 25 (8.4%) as high suspicion at US. Considering only FNA cytology (n = 230), 6.9% were revealed as Bethesda class I, 16.1% as class II, 37.0% as class III, 29.1% as class IV and 10.9% as class V. Considering the 68 cases with CNB results, 2.9% were revealed as class I, 4.4% as class II, 20.6% as class III and 72.1% as class IV. Despite multiple FNAs, 16.7% of the 84 patients with FTC still obtained Bethesda class I or class II. CNB results in patients with FTC had a significantly higher rate of Bethesda class IV compared to the FNA results (P < .001). FTCs with distant metastasis exhibited a significantly higher rate of Bethesda classes IV and V compared to those without distant metastasis (P = .004).
Surgery for FTC is deferred only with preoperative US and FNA. CNB in patients with FTC can lead to surgery better than FNA. Therefore, if the US feature is characteristic and a serially growing large nodule is suspected, the first attempt of CNB may be helpful in selecting a surgical candidate.
评估超声（US）、细针穿刺抽吸（FNA）和核心针活检（CNB）在术前诊断 FTC 中的诊断价值。
本研究纳入 1994 年 10 月至 2016 年 7 月间 298 例接受 US 引导下 FNA 或 CNB 及手术的 FTC 患者。我们根据 Bethesda 系统评估术前 FNA 或 CNB 结果，根据韩国甲状腺影像报告和数据系统（K-TIRADS）评估 US 结果。
FTC 的主要 US 特征为实性、低或等回声、椭圆形光滑边界和无钙化晕。根据 K-TIRADS，140 例（47.0%）FTC 患者 US 低度可疑，133 例（44.63%）中度可疑，25 例（8.4%）高度可疑。仅考虑 FNA 细胞学（n=230），6.9%为 Bethesda Ⅰ级，16.1%为Ⅱ级，37.0%为Ⅲ级，29.1%为Ⅳ级，10.9%为Ⅴ级。考虑到 68 例 CNB 结果，2.9%为Ⅰ级，4.4%为Ⅱ级，20.6%为Ⅲ级，72.1%为Ⅳ级。尽管多次进行 FNA，仍有 16.7%的 84 例 FTC 患者仍获得 Bethesda Ⅰ级或Ⅱ级。FTC 患者的 CNB 结果比 FNA 结果的 Bethesda Ⅳ级比例显著更高（P<0.001）。有远处转移的 FTC 比无远处转移的 FTC 更易出现 Bethesda Ⅳ级和Ⅴ级（P=0.004）。
仅术前 US 和 FNA 即可延迟 FTC 手术。FTC 患者的 CNB 可优于 FNA 导致手术。因此，如果 US 特征具有特征性，且怀疑是逐渐增大的大结节，则首次尝试 CNB 可能有助于选择手术候选者。
