Department of Otolaryngology, San Antonio Military Medical Center, San Antonio, TX, USA.
Department of Otolaryngology, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Ann Otol Rhinol Laryngol. 2021 Sep;130(9):1064-1068. doi: 10.1177/0003489421993976. Epub 2021 Feb 10.
An indeterminate thyroid nodule fine-needle aspiration (FNA) presents a unique dilemma. We evaluated our institution's experience with Bethesda III thyroid nodules, including the risk of malignancy (ROM) of these nodules removed for diagnostic lobectomy and radiologic and clinical risk factors for malignancy.
Retrospective chart review.
San Antonio Military Medical Center (SAMMC; 483 bed Military Treatment Facility and Level 1 Trauma Center).
We identified all patients with a Bethesda III thyroid FNA at our institution from 2010 to 2018 and determined which nodules were removed. The final histological diagnosis was recorded. Whether or not age, gender, body mass index (BMI), race, nodule size, margin regularity, rate of nodule growth, vascularity, internal calcifications, family history of thyroid cancer, personal history of radiation, and history of repeated AUS/FLUS on FNA had a significant impact on malignancy risk was evaluated with chi square and rank sum Wilcoxon tests.
492 patients had 1 or more AUS result. 52% (258/492) underwent repeat FNA. This resulted in Bethesda II or III in 90% (232/258). In 10% (26/258), the repeat FNA resulted in a higher Bethesda grade. 183 lobectomies were performed on the side containing an AUS nodule. The malignancy percentage was 38.3% (70/183). Age less than 30 was the only variable showing statistical significance for increased risk of malignancy ( = .04).
The ROM of nodules characterized as AUS/FLUS on FNA may be higher than expected. Age may be a better predictor of malignancy than repeat FNA.
甲状腺细针抽吸活检（FNA）结果不确定的甲状腺结节带来了独特的困境。我们评估了本机构在 Bethesda Ⅲ级甲状腺结节方面的经验，包括因诊断性 lobectomy 而切除的这些结节的恶性肿瘤风险（ROM）以及恶性肿瘤的放射学和临床危险因素。
回顾性图表审查。
圣安东尼奥军事医疗中心（SAMMC；483 张床位的军事治疗设施和一级创伤中心）。
我们确定了 2010 年至 2018 年期间在我们机构进行的所有 Bethesda Ⅲ级甲状腺 FNA 患者，并确定了切除的结节。记录最终的组织学诊断。使用卡方检验和秩和 Wilcoxon 检验评估年龄、性别、体重指数（BMI）、种族、结节大小、边缘规则性、结节生长速度、血管分布、内部钙化、甲状腺癌家族史、个人辐射史以及 FNA 上的重复 AUS/FLUS 史是否对恶性肿瘤风险有显著影响。
492 例患者有 1 个或多个 AUS 结果。52%（258/492）患者进行了重复 FNA。这导致 90%（232/258）的患者的 Bethesda 分级为 II 或 III 级。在 10%（26/258）的患者中，重复 FNA 导致更高的 Bethesda 分级。183 例 lobectomies 在包含 AUS 结节的一侧进行。恶性肿瘤百分比为 38.3%（70/183）。年龄小于 30 岁是唯一显示恶性肿瘤风险增加的变量（ = .04）。
在 FNA 上表现为 AUS/FLUS 的结节的 ROM 可能高于预期。年龄可能比重复 FNA 更能预测恶性肿瘤。
