Tufts University, School of Medicine, Boston, Massachusetts.
Department of Otolaryngology-Head and Neck Surgery, Harvard Vanguard Medical, Associates/Atrius Health, Boston, Massachusetts.
Endocr Pract. 2022 Jun;28(6):593-598. doi: 10.1016/j.eprac.2022.03.011. Epub 2022 Mar 17.
Hürthle cells are a common finding on thyroid fine-needle aspiration, but when they are the predominant cytology, they represent a difficult diagnostic challenge. The Thyroid Nodule App (TNAPP) is a new, publicly available web application utilizing ultrasound (US) features based on the updated 2016 American Association of Clinical Endocrinologists clinical practice guidelines for thyroid nodule management. This pilot study was performed to assess the TNAPP recommendations and surgical pathology outcomes of Hürthle cell-predominant thyroid nodules.
A retrospective review of nodules with Bethesda III (atypia of undetermined significance with Hürthle cells) or Bethesda IV (suspicious for Hürthle cell neoplasm) cytology, for which surgery was performed between 2017 and 2021, was conducted. TNAPP US categories 1, 2, and 3 (low, intermediate, and high risk, respectively) were assigned based on nodule characteristics, and clinical management recommendations were recorded. Results were compared with histology-proven diagnoses.
Fifty-nine nodules in 57 patients where surgical pathology was available were analyzed with the TNAPP algorithm. Of the 59 nodules, 4 were US category 1 (low risk/suspicion), 40 were US category 2 (intermediate risk/suspicion), and 15 were US category 3 (high risk/suspicion). All US category 1 nodules were benign, while 30% of the US category 2 and 40% of the US category 3 nodules were malignant. Of the patients who had molecular marker testing with ThyroSeq, 22 out of 29 (76%) were positive, indicating either an intermediate or high risk of malignancy, 7 of which were malignant.
This preliminary study suggests that TNAPP is a useful clinical tool for sonographic assessment of thyroid nodules with Hürthle cell cytology.
甲状腺细针抽吸细胞学检查中常见到 Hurthle 细胞，但当 Hurthle 细胞为主时，诊断极具挑战性。甲状腺结节应用程序（Thyroid Nodule App，TNAPP）是一种新的、公开可用的网络应用程序，利用基于 2016 年美国临床内分泌医师协会甲状腺结节管理临床实践指南更新的超声（US）特征。本研究旨在评估 TNAPP 对 Hurthle 细胞为主的甲状腺结节的推荐意见和手术病理结果。
对 2017 年至 2021 年间行手术治疗的 Bethesda III 级（意义不明的 Hurthle 细胞不典型性）或 Bethesda IV 级（可疑 Hurthle 细胞肿瘤）细胞学的结节进行回顾性分析。根据结节特征分配 TNAPP US 类别 1、2 和 3（分别为低、中、高危），并记录临床管理建议。将结果与组织病理学诊断进行比较。
对 57 例手术病理资料完整的患者的 59 个结节进行了 TNAPP 算法分析。59 个结节中，4 个为 US 类别 1（低危/可疑），40 个为 US 类别 2（中危/可疑），15 个为 US 类别 3（高危/可疑）。所有 US 类别 1 结节均为良性，而 30%的 US 类别 2 结节和 40%的 US 类别 3 结节为恶性。在进行 ThyroSeq 分子标志物检测的 29 例患者中，22 例（76%）呈阳性，提示中危或高危恶性风险，其中 7 例为恶性。
本初步研究表明，TNAPP 是评估 Hurthle 细胞为主的甲状腺结节的有用临床工具。
