Department of Surgery, Hamad General Hospital (HGH) , Doha, Qatar.
Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital (HGH) , Doha, Qatar.
Postgrad Med. 2020 Jun;132(5):465-472. doi: 10.1080/00325481.2020.1741298. Epub 2020 Mar 18.
Thyroid fine needle aspiration (FNA) is the mainstay for diagnosis of malignancy, and is an integral part of current thyroid nodule assessment. The present study analyzes the diagnostic accuracy of palpation-directed versus ultrasound guided fine-needle aspiration in patients who underwent surgery for thyroid nodules.
A retrospective chart review of all consecutive patients who had FNA biopsy (palpation or ultrasound guided) of thyroid nodules and underwent thyroid gland surgery between 1998 and 2014 was conducted. The FNA findings of the palpation-guided and ultrasound-guided groups were compared for baseline characteristics. Moreover, the diagnostic accuracy of FNA findings and surgical histopathology results were analyzed.
A total of 1174 patients were included in the study with a mean age of 46.3 ± 11.7 years and the majority were females (75.5%). Among the study population, 392 (33.4%) patients underwent US-guided FNA; 570 (48.6%) had palpation-guided FNA in clinic and no FNA was done in 212 (18%) cases. Patients underwent US-guided FNA were more likely to have suspicion of malignancy ( = 0.001), and had indeterminate findings ( = 0.001). On the other hand, palpation-guided FNA group had significantly higher frequency of benign cytology ( = 0.001). With respect to the suspicion for malignancy as well as malignancy, the US-guided group had a similar diagnostic accuracy in comparison to the palpation group. The proportion of malignancy finding on US-guided FNA (8.9%) was higher than the palpation-guided FNA (6.4%) that had been confirmed on postoperative histopathological examination ( = 0.95).
The present study demonstrates higher sensitivity of US-guided thyroid FNA biopsies over palpation-guided FNA for the suspicion of malignancy; however, the accuracy is comparable. Moreover, both groups showed more postoperative malignancy in the benign and unsatisfactory categories than predicted in the Bethesda system. Further prospective studies are needed to underpin a realistic correlation between FNA and final histopathology reports.
甲状腺细针抽吸（FNA）是诊断恶性肿瘤的主要方法，也是当前甲状腺结节评估的重要组成部分。本研究分析了在因甲状腺结节而接受手术的患者中，触诊引导与超声引导下细针抽吸的诊断准确性。
对 1998 年至 2014 年间接受甲状腺结节 FNA 活检（触诊或超声引导）并接受甲状腺手术的所有连续患者进行回顾性图表审查。比较触诊引导组和超声引导组的 FNA 结果的基线特征。此外，还分析了 FNA 结果与手术组织病理学结果的诊断准确性。
共有 1174 例患者纳入研究，平均年龄为 46.3±11.7 岁，大多数为女性（75.5%）。在研究人群中，392 例（33.4%）患者接受了超声引导下 FNA；570 例（48.6%）在诊所进行了触诊引导下 FNA，212 例（18%）未进行 FNA。接受超声引导 FNA 的患者更有可能有恶性肿瘤的怀疑（=0.001），且有不确定的发现（=0.001）。另一方面，触诊引导 FNA 组良性细胞学的频率明显更高（=0.001）。就恶性肿瘤的怀疑和恶性肿瘤本身而言，超声引导组与触诊组的诊断准确性相似。超声引导 FNA 发现恶性肿瘤的比例（8.9%）高于术后组织病理学检查证实的触诊引导 FNA（6.4%）（=0.95）。
本研究表明，超声引导下甲状腺 FNA 活检对恶性肿瘤的怀疑比触诊引导 FNA 具有更高的敏感性；然而，准确性相当。此外，两组在良性和不满意类别中的术后恶性肿瘤比例均高于 Bethesda 系统预测的比例。需要进一步的前瞻性研究来支持 FNA 与最终组织病理学报告之间的现实相关性。
