Laboratory for Endocrine Disruptors, Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy.
Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
Eur J Endocrinol. 2021 Jun 28;185(2):201-208. doi: 10.1530/EJE-21-0094.
Indeterminate cytological result at fine-needle aspiration cytology (FNAC) remains a clinical challenge for endocrinologists. Aim of the present study was to evaluate whether a coexistent chronic autoimmune thyroiditis (CAT) might affect the diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules.
A retrospective cohort study was designed including all nodules receiving an indeterminate cytology result (TIR3A or TIR3B) undergoing thyroid surgery and subsequent histological confirmation. Patients were stratified into two groups according to the presence or absence of CAT. The hypothesis to be tested was whether follicular cell alterations induced by CAT might increase the rate of indeterminate cytological results in histologically benign thyroid nodules. Additional control groups were represented by nodules with determinate cytology, either benign (TIR 2) or malignant (TIR5).
One hundred and eighty-nine indeterminate thyroid nodules were included (67 TIR3A and 122 TIR3B). At post-surgical histology, 46 nodules (24.3%) were malignant. No significant differences were observed in the rate of histologically proven malignancy between patients without CAT and patients with CAT in the TIR3B (29.4% vs 32.4%; P = 0.843) nor TIR3A (13.0% vs 11.4%; P = 1.000) nodules. The rate of coexistent CAT was similar between TIR3B and TIR5 nodules harboring PTC at histology (30.4% vs 39.4%, P = 0.491) and between indeterminate nodules and a control group of TIR2 nodules (39.2% vs 37.0%; P = 0.720).
The similar rates of histologically proven malignancy found in cytologically indeterminate nodules in the presence or absence of concomitant CAT would not support that CAT itself affects the diagnostic accuracy of fine-needle aspiration cytology.
细针穿刺细胞学检查（FNAC）结果不确定仍然是内分泌学家面临的临床挑战。本研究旨在评估共存的慢性自身免疫性甲状腺炎（CAT）是否会影响甲状腺结节细针穿刺细胞学的诊断准确性。
设计了一项回顾性队列研究，纳入所有接受不确定细胞学结果（TIR3A 或 TIR3B）并接受甲状腺手术及随后组织学证实的结节患者。根据是否存在 CAT，将患者分为两组。要检验的假设是 CAT 引起的滤泡细胞改变是否会增加组织学良性甲状腺结节中不确定细胞学结果的发生率。另外的对照组由具有确定性细胞学结果的结节组成，良性（TIR2）或恶性（TIR5）。
纳入了 189 个不确定的甲状腺结节（67 个 TIR3A 和 122 个 TIR3B）。术后组织学检查，46 个结节（24.3%）为恶性。在 TIR3B（29.4% vs 32.4%；P = 0.843）和 TIR3A（13.0% vs 11.4%；P = 1.000）结节中，无 CAT 患者和有 CAT 患者的组织学证实恶性率无显著差异。在组织学证实为 PTC 的 TIR3B 和 TIR5 结节以及 TIR3B 和 TIR5 结节中，CAT 的共存率相似（30.4% vs 39.4%，P = 0.491），在不确定的结节和 TIR2 结节的对照组之间（39.2% vs 37.0%；P = 0.720）也是如此。
在伴有或不伴有 CAT 的情况下，细胞学不确定的结节中发现的组织学证实恶性率相似，这并不支持 CAT 本身会影响细针穿刺细胞学的诊断准确性。
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