Karakas Hakki M, Bicer Gulsah, Findik Ozge, Kahraman Ahmet Nedim
Radiology, University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR.
Cureus. 2020 Jan 22;12(1):e6740. doi: 10.7759/cureus.6740.
Two different methods for fine needle aspiration biopsy (FNAB) of thyroid nodules (multi-pass conventional smear, MPCS; single-pass liquid-based cytology, SPLBC) were evaluated regarding the magnitude of nondiagnostic/unsatisfactory sampling ratio, and basic demographic and ultrasonographic (USG) factors to predict such outcome.
One thousand FNAB patients were retrospectively assessed. Of them, 517 nodules were evaluated with the conventional smear method, and the rest were evaluated with liquid-based cytology method using the Bethesda System for Reporting Thyroid Cytopathology. FNAB technique had certain procedural differences for both pathological methods. For conventional smear, a modified "needle-only" technique with three independent passes was performed, whereas a single pass was used for liquid-based cytology. The reduction of nondiagnostic/unsatisfactory results constituted the basis of this study. Pathological results, therefore, were subgrouped under "nondiagnostic/unsatisfactory" (Category I), "benign" (Category II), and "atypia/neoplasia/malignancy" (Category III-VI).
Both FNAB groups were not statistically different or only slightly different regarding size ( = 0.196), echogenicity ( = 0.014), and the presence of echogenic foci ( = 0.11), therefore considered to have equal USG properties. In MPCS method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 24%. Other cytological results were as follows: Category II (67.1%), Category III-VI (8.8%). In SPLBC method, the nondiagnostic/unsatisfactory rate (i.e., Category I) was 14.5%. Other cytological results were as follows: Category II (77.6%), Category III-VI (7.8%). A significant difference was found between two sampling methods regarding pathological results (Independent samples t-test, < 0.0001). The demographic and USG factors, considered in this study, did not offer a successful prediction of nondiagnostic/unsatisfactory outcomes.
SPLBC has significantly lower (14.5% vs 24%) nondiagnostic rate than MPCS, and higher 77.6% vs 67.1%) Category II rate than MPCS. This may point to the possibility that MPCS method undercategorizes many benign (i.e., Category II) nodules under nondiagnostic/unsatisfactory category. The success of the former is due to the elimination of confounding material during the process. Single pass, also, increases patient comfort and compliance, and has additional advantages for the interventionalist, as it obviates the need to smear aspirates. This dramatically decreases the actual duration of the biopsy procedure and is free of interventionalist expertise for smearing.
评估两种不同的甲状腺结节细针穿刺活检（FNAB）方法（多针道传统涂片法，MPCS；单针道液基细胞学检查法，SPLBC）的非诊断性/不满意采样率大小，以及预测该结果的基本人口统计学和超声（USG）因素。
对1000例接受FNAB的患者进行回顾性评估。其中，517个结节采用传统涂片法评估，其余结节采用基于液基细胞学的方法，并使用贝塞斯达甲状腺细胞病理学报告系统。两种病理方法的FNAB技术在操作程序上存在一定差异。对于传统涂片，采用改良的“仅针”技术，进行三次独立穿刺，而液基细胞学检查则采用单次穿刺。减少非诊断性/不满意结果是本研究的基础。因此，病理结果被分为“非诊断性/不满意”（I类）、“良性”（II类）和“非典型/肿瘤/恶性”（III-VI类）亚组。
两个FNAB组在大小（P = 0.196）、回声性（P = 0.014）和回声灶的存在（P = 0.11）方面无统计学差异或仅有轻微差异，因此被认为具有相同的USG特性。在MPCS方法中，非诊断性/不满意率（即I类）为24%。其他细胞学结果如下：II类（67.1%），III-VI类（8.8%）。在SPLBC方法中，非诊断性/不满意率（即I类）为14.5%。其他细胞学结果如下：II类（77.6%），III-VI类（7.8%）。两种采样方法在病理结果方面存在显著差异（独立样本t检验，P < 0.0001）。本研究中考虑的人口统计学和USG因素未能成功预测非诊断性/不满意结果。
SPLBC的非诊断率（14.5%对24%）显著低于MPCS，II类率（77.6%对67.1%）高于MPCS。这可能表明MPCS方法可能将许多良性（即II类）结节错误分类为非诊断性/不满意类别。前者的成功归因于在过程中消除了混杂物质。单次穿刺也提高了患者的舒适度和依从性，对介入医生还有额外的优势，因为它无需对吸出物进行涂片。这显著缩短了活检程序的实际时间，并且无需介入医生具备涂片专业知识。
