Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Thyroid. 2020 Mar;30(3):425-431. doi: 10.1089/thy.2019.0190.
Hürthle cell/oncocytic change is commonly reported on thyroid fine-needle aspiration (FNA) and may be considered an "atypical cell" by clinicians. This study aims to delineate the association between Hürthle cells in preoperative cytology and subsequent pathology of the indexed thyroid nodule and to report rates of malignancy. Retrospective review of records of 300 patients with Hürthle cell/oncocytic change on FNA and final surgical pathology at a tertiary referral center between 2000 and 2013 was performed and compared with a multi-institutional FNA cohort. The degree of Hürthle cell presence was correlated with histopathologic diagnoses. In the Hürthle cell FNA group, Bethesda System for Reporting Thyroid Cytopathology (BSRTC) categories were as follows: I (nondiagnostic) 14 (4.7%); II (benign) 113 (37.7%); III (atypia of undetermined significance/follicular lesion of undetermined significance) 33 (11%); IV (follicular neoplasm/suspicious for a follicular neoplasm) 125 (41.6%); V (suspicious for malignancy) 12 (4%); and VI (malignant) 3 (1%). When categorized based on the degree of Hürthle cell change, 59 (29%) were classified as mild, 13 (6%) moderate, and 131 (65%) as predominant. When comparing the results with a multi-institutional FNA cohort (all with surgical confirmation), the presence of Hürthle cells was found to be associated with a lower risk of malignancy in all BSRTC categories, with a statistically significant difference in the BSRTC IV and V groups. The sole exception was when Hürthle cell presence was classified as predominant (defined as >75% of the cellular population); the rate of malignancy was significantly elevated in FNAs interpreted as benign/Bethesda II. Although Hürthle cells have been considered by clinicians as an "atypical cell," their presence does not increase the risk of malignancy within BSRTC categories overall. However, when predominant Hürthle cell change is present, the risk of malignancy is increased in the benign cytology/BSRTC category II.
甲状腺细针抽吸细胞学检查（FNA）中常报告 Hurthle 细胞/嗜酸细胞改变，临床医生可能将其视为“非典型细胞”。本研究旨在阐明术前细胞学中 Hurthle 细胞与索引性甲状腺结节的后续病理之间的关系，并报告恶性肿瘤的发生率。对 2000 年至 2013 年在三级转诊中心接受 Hurthle 细胞/嗜酸细胞改变 FNA 和最终外科病理检查的 300 例患者的记录进行回顾性分析，并与多机构 FNA 队列进行比较。Hurthle 细胞的存在程度与组织病理学诊断相关。在 Hurthle 细胞 FNA 组中，Bethesda 甲状腺细胞病理学报告系统（BSRTC）类别如下：I（非诊断性）14 例（4.7%）；II（良性）113 例（37.7%）；III（意义不明确的非典型性/滤泡性病变意义不明确）33 例（11%）；IV（滤泡性肿瘤/滤泡性肿瘤可疑）125 例（41.6%）；V（疑似恶性肿瘤）12 例（4%）；VI（恶性）3 例（1%）。当根据 Hurthle 细胞变化程度进行分类时，59 例（29%）为轻度，13 例（6%）为中度，131 例（65%）为主要。与多机构 FNA 队列（均经手术证实）的结果进行比较时，发现所有 BSRTC 类别中存在 Hurthle 细胞与恶性肿瘤风险降低相关，BSRTC IV 和 V 组的差异具有统计学意义。唯一的例外是当 Hurthle 细胞存在被归类为主要（定义为>75%的细胞群体）时；在良性/Bethesda II 解读的 FNAs 中，恶性肿瘤的发生率显著升高。虽然 Hurthle 细胞被临床医生视为“非典型细胞”，但它们在 BSRTC 类别中的存在并不会增加总体恶性肿瘤风险。然而，当主要 Hurthle 细胞改变存在时，良性细胞学/BSRTC 类别 II 中的恶性肿瘤风险增加。
