术前细胞学检查对甲状腺髓样癌的局限性：为优化初始甲状腺髓样癌特异性手术提出的改进术前诊断建议。
Limitations of preoperative cytology for medullary thyroid cancer: Proposal for improved preoperative diagnosis for optimal initial medullary thyroid carcinoma specific surgery.
机构信息
Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Head Neck. 2021 Mar;43(3):920-927. doi: 10.1002/hed.26550. Epub 2020 Dec 2.
BACKGROUND
Preoperative diagnosis of medullary thyroid carcinoma (MTC) is often difficult, given the poor sensitivity of fine-needle aspiration (FNA) cytology for MTC. This study investigates this issue and presents recommendations for improving preoperative diagnostic paradigms in MTC cases.
DESIGN/METHOD: Histopathologically confirmed MTC patients with preoperative cytologic assessment of index nodules were enrolled. FNA diagnosis, final pathology, and surgery details were collected.
RESULTS
Out of 71 patients, 49 (69%) were diagnosed by FNA as either definitive MTC (35, 49%) or suspected MTC (14, 20%) and 22 (31%) patients had no indication of MTC on FNA.
CONCLUSION
In a tertiary-care setting, one-third of subjects had an FNA interpretation that did not suggest the possibility of MTC. The limitations of preoperative diagnosis are especially problematic for MTC as they can cause delayed or incomplete treatment. Additional testing is proposed to improve preoperative diagnosis and surgical care of MTC patients.
背景
由于细针穿刺细胞学检查（FNA）对甲状腺髓样癌（MTC）的敏感性较差，因此术前诊断 MTC 往往较为困难。本研究探讨了这一问题，并提出了改善 MTC 患者术前诊断模式的建议。
设计/方法：入组了经组织病理学证实的 MTC 患者，这些患者在术前对索引结节进行了细胞学评估。收集了 FNA 诊断、最终病理和手术细节。
结果
71 例患者中，49 例（69%）经 FNA 诊断为明确的 MTC（35 例，49%）或疑似 MTC（14 例，20%），22 例（31%）患者的 FNA 未提示 MTC。
结论
在三级保健机构中，三分之一的患者的 FNA 检查结果不提示 MTC 的可能性。术前诊断的局限性对 MTC 尤其成问题，因为它们可能导致治疗延迟或不彻底。建议进行额外的检测以改善 MTC 患者的术前诊断和手术护理。
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