Oxford University Hospitals NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2022 Nov;104(9):703-709. doi: 10.1308/rcsann.2021.0358. Epub 2022 Apr 21.
Fine-needle aspiration cytology (FNAC) is an integral part of thyroid nodule assessment. Nodules with an indeterminate cytology (THY3a-f) require formal histological assessment to confirm benign or malignant pathology. This study aimed to provide data for an evidence-based approach for management of patients with THY3f nodules.
Retrospective review of patients who had a thyroid FNAC reported as suspicious of follicular neoplasm (THY3f) or showing atypia (THY3a) were identified, and clinical, operative and outcomes data were analysed.
Between 2018 and 2020, 200 patients (167F:33M, median age 51 years (range:18-86 years)) had a THY3f cytology. Most presented with a palpable nodule (=104; 68.4%). Overall, 152 (76.0%;130F:23M) underwent surgery and 31 (20.4%) were found to have a thyroid carcinoma (22 follicular carcinomas, 7 papillary carcinomas, 1 medullary thyroid carcinoma and 1 metastatic renal carcinoma). An additional incidental carcinoma (size: 0.7-13mm) was found in seven (4.6%). Among those with cancer, a completion thyroidectomy and radioactive iodine treatment was indicated in nine (<6% of the entire cohort). Previously suggested risk factors for malignancy, eg male gender, large tumour size (>4cm) or age, were not found to be associated with increased risk. During the same period, THY3a cytology was reported in 53 patients, of whom 29 underwent diagnostic surgery and 4 patients were found to have a thyroid cancer (follicular, =3 and medullary, =1).
One in five patients with features suspicious of a follicular neoplasm (THY3f) has a thyroid carcinoma. This risk is much lower for THY3a. This study reinforces the current recommendation for thyroid surgery in all patients with a reliable THY3f cytology, as no further stratifying risk factors could be identified.
细针穿刺细胞学检查（FNAC）是甲状腺结节评估的重要组成部分。细胞学不确定的结节（THY3a-f）需要进行正式的组织学评估以确定良性或恶性病变。本研究旨在为管理 THY3f 结节患者提供循证方法的数据。
回顾性分析了 2018 年至 2020 年间甲状腺 FNAC 报告为滤泡性肿瘤可疑（THY3f）或显示不典型性（THY3a）的患者，分析了其临床、手术和结局数据。
在 2018 年至 2020 年间，有 200 名患者（167 名女性：33 名男性，中位年龄 51 岁（范围：18-86 岁））的 THY3f 细胞学结果。大多数患者表现为可触及的结节（=104；68.4%）。总体而言，有 152 名（76.0%；130 名女性：23 名男性）患者接受了手术，31 名（20.4%）发现甲状腺癌（22 例滤泡癌、7 例乳头状癌、1 例髓样癌和 1 例转移性肾细胞癌）。另外还在 7 名患者（4.6%）中发现了意外的癌（大小：0.7-13mm）。在患有癌症的患者中，有 9 名（整个队列的<6%）需要进行全甲状腺切除术和放射性碘治疗。先前被认为与恶性肿瘤相关的风险因素，如男性、大肿瘤大小（>4cm）或年龄，并未发现与风险增加相关。在此期间，53 名患者的细胞学结果为 THY3a，其中 29 名患者接受了诊断性手术，4 名患者发现患有甲状腺癌（滤泡癌，=3 例和髓样癌，=1 例）。
每五个具有滤泡性肿瘤可疑特征的患者（THY3f）中就有一个患有甲状腺癌。THY3a 的风险要低得多。本研究再次证实了目前对所有具有可靠 THY3f 细胞学结果的患者进行甲状腺手术的建议，因为无法确定其他分层风险因素。
