Shindo Hisakazu, Kakudo Kennichi, Inomata Keiko, Mori Yusuke, Takahashi Hiroshi, Satoh Shinya, Yamashita Hiroyuki
Department of Surgery, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan.
Thyroid Disease Center, Department of Pathology, City General Hospital, Osaka 594-0073, Japan.
Cancers (Basel). 2021 Mar 12;13(6):1270. doi: 10.3390/cancers13061270.
This study aimed to determine whether additional tissue sampling of encapsulated thyroid nodules would increase the frequency of follicular thyroid carcinoma (FTC) diagnoses. We examined thyroid tissue specimens from 86 patients suspected of FTC (84.9% female; mean age, 49.0 ± 17.8 years). The number of tissue blocks created for pathological assessments ranged from 3 to 20 (mean, 9.1 ± 4.1); the numbers in the previous method recommended by the Japanese General Rules for the Description of Thyroid Cancer and additional blocks ranged from 1 to 12 (mean, 6.0 ± 2.8) and from 1 to 8 (mean, 3.1 ± 2.0), respectively. The additional blocks were subsequently examined to determine whether any diagnoses changed from those based on the previous method. Five patients were diagnosed with FTC using the previous method; however, additional tissue blocks led to the diagnosis of FTC in 6 patients, as 1 diagnosis was revised from follicular adenoma to FTC. It has been reported that increasing the number of tissue blocks used for pathological assessments can increase the frequency of FTC diagnoses; however, this was not clinically significant in thyroid carcinoma, which requires completion thyroidectomy and radioactive iodine treatment. It resulted in no benefits to the patient because all minimally invasive FTCs, follicular tumors of uncertain malignant potential (FT-UMP), and follicular adenomas are treated with lobectomy alone in Japan. Additional tissue sampling only had a slight impact on our thyroid practice; therefore, we decided to cease it.
本研究旨在确定对甲状腺包膜内结节进行额外的组织采样是否会增加滤泡状甲状腺癌（FTC）的诊断频率。我们检查了86例疑似FTC患者的甲状腺组织标本（女性占84.9%；平均年龄49.0±17.8岁）。用于病理评估的组织块数量为3至20个（平均9.1±4.1个）；按照日本甲状腺癌描述总则推荐的先前方法所取组织块数量为1至12个（平均6.0±2.8个），额外组织块数量为1至8个（平均3.1±2.0个）。随后对额外组织块进行检查，以确定与基于先前方法的诊断相比是否有任何诊断发生变化。使用先前方法诊断出5例FTC；然而，额外组织块使6例患者被诊断为FTC，因为有1例诊断从滤泡性腺瘤修正为FTC。据报道，增加用于病理评估的组织块数量可提高FTC的诊断频率；然而，这在甲状腺癌中并无临床意义，因为甲状腺癌需要进行甲状腺全切术和放射性碘治疗。在日本所有微小浸润性FTC、恶性潜能不确定的滤泡性肿瘤（FT-UMP）和滤泡性腺瘤仅行甲状腺叶切除术治疗，因此对患者并无益处。额外组织采样对我们的甲状腺诊疗实践影响甚微；因此我们决定停止此项操作。
