Matrone Antonio, De Napoli Luigi, Torregrossa Liborio, Aghababyan Aleksandr, Papini Piermarco, Ambrosini Carlo Enrico, Cervelli Rosa, Ugolini Clara, Basolo Fulvio, Molinaro Eleonora, Elisei Rossella, Materazzi Gabriele
Department of Clinical and Experimental Medicine, Unit of Endocrinology, University Hospital of Pisa, Pisa, Italy.
Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, University Hospital of Pisa, Pisa, Italy.
Front Oncol. 2022 Apr 5;12:854755. doi: 10.3389/fonc.2022.854755. eCollection 2022.
Large thyroid masses, particularly if rapidly growing, are often characterized by compression and infiltration of the vital structures of the neck. Therefore, an early and precise diagnosis, not only of malignancy but also of histotype, is mandatory to set up the right therapy. The aim of this study was to evaluate the diagnostic performance of fine needle aspiration cytology (FNAC) and core needle biopsy (CNB) in this setting.
We prospectively evaluated 95 patients with large and rapidly growing thyroid masses admitted to the University Hospital of Pisa between April 2014 and January 2020. All patients were submitted to FNAC and CNB in the same session. The ability of both procedures to diagnose the malignancy of the lesions, particularly the histotype, and to obtain sufficient material to perform molecular analysis was evaluated.
FNAC obtained adequate tumor sample to reach a diagnosis in 76 of 95 (80%) patients, while a higher percentage was obtained with CNB (92/95, 96.8%). FNAC was able to identify the malignancy of the lesion in 74 of 95 (77.9%) cases, but only in 16 of 74 (21.6%) cases was it able to define the histotype. CNB was able to define the malignancy of the lesion in all but three cases (92/95, 96.8%), and in all specimens, the histotype was identified. Moreover, in all cases, the material extracted from CNB was optimal to perform molecular analysis. No surgery-related complications were experienced with both procedures.
CNB is a rapid and safe procedure with higher performance compared to FNAC in identifying the histotype of large and rapidly growing thyroid masses. Moreover, adequate material can be obtained to characterize the molecular profile for the treatment of potentially lethal cancers. In the era of precision medicine, CNB should be introduced in routine clinical practice as a key procedure for an early diagnosis and therapy of these diseases.
巨大甲状腺肿块，尤其是生长迅速的肿块，常表现为对颈部重要结构的压迫和浸润。因此，不仅要早期准确诊断恶性肿瘤，还要明确组织类型，这对于制定正确的治疗方案至关重要。本研究的目的是评估细针穿刺细胞学检查（FNAC）和粗针穿刺活检（CNB）在这种情况下的诊断性能。
我们前瞻性评估了2014年4月至2020年1月期间入住比萨大学医院的95例患有巨大且生长迅速的甲状腺肿块的患者。所有患者在同一次就诊时均接受了FNAC和CNB检查。评估了这两种检查方法诊断病变恶性肿瘤的能力，特别是组织类型，以及获取足够材料进行分子分析的能力。
FNAC在95例患者中的76例（80%）获得了足够的肿瘤样本以做出诊断，而CNB获得足够样本的比例更高（92/95，96.8%）。FNAC在95例病例中的74例（77.9%）能够识别病变的恶性肿瘤，但在74例中的16例（21.6%）能够明确组织类型。CNB除3例（92/95，96.8%）外，能够在所有病例中明确病变的恶性肿瘤，并且在所有标本中都能识别组织类型。此外，在所有病例中，从CNB提取的材料对于进行分子分析是最佳的。两种检查方法均未出现与手术相关的并发症。
与FNAC相比，CNB是一种快速、安全的检查方法，在识别巨大且生长迅速的甲状腺肿块的组织类型方面具有更高的性能。此外，可以获得足够的材料来表征分子特征，以用于治疗潜在的致命癌症。在精准医学时代，CNB应作为这些疾病早期诊断和治疗的关键检查方法引入常规临床实践。
