Uçak R, Mut D Türkyilmaz, Kaya C, Ozguven B Yilmaz, Kabukcuoglu F, Uludağ M
University of Health Sciences, Sisli Hamidiye Etfal Health Application and Research Center, Department of Pathology, Istanbul, Turkey.
University of Health Sciences, Sisli Hamidiye Etfal Health Application and Research Center, Department of Radiology, Istanbul, Turkey.
Acta Endocrinol (Buchar). 2022 Jan-Mar;18(1):127-133. doi: 10.4183/aeb.2022.127.
CONTEXT/OBJECTIVE: The standard approach is to perform repeat FNAB (rFNAB) in thyroid nodules with non-diagnostic (ND) / insufficient (UNS) cytology. However, due to the nature of these nodules, recurrent FNABs may also be insufficient. Therefore, by comparing the clinical-radiological-pathological parameters of nodules with a definite diagnosis of excision, we questioned the possibility of patient management without rFNAB.
Clinical-radiological parameters of 275 nodules belonging to 264 patients in the ND/UNS aspiration group with definite pathological diagnosis after surgery were determined. Under the guidance of these parameters, those with and without rFNAB were compared.
The incidence of malignancy was found to be significantly higher in nodules without rFNAB compared to nodules with rFNAB (p = 0.036). In addition, the incidence of malignancy in BC-1 nodules without rFNAB was significantly higher than in nodules with rFNAB result also BC-1 (p = 0.009). In all cases, nodule size smaller than 10 mm and border irregularity were found to be statistically significant for malignancy (p <0.020, p <0.002). When looking at the distribution of rFNAB results, a significant correlation was observed with female gender, solid component, hypoechogenicity, border irregularity and halo loss around the nodule in patients with BC-4,5,6 cytology results (respectively, 0.005 / 0.031 / 0.001 / 0.012 / 0.004).
rFNAB did not show the expected effect in ND / UNS nodules. We recommend direct surgical excision without rFNAB for nodules with border irregularity, solid structure, halo loss and hypoechogenicity, which should be considered more important in female patients.
背景/目的：标准方法是对甲状腺结节细针穿刺抽吸活检（FNAB）结果为非诊断性（ND）/不充分（UNS）的情况进行重复FNAB（rFNAB）。然而，由于这些结节的性质，重复FNAB也可能不充分。因此，通过比较经手术明确诊断切除的结节的临床-放射-病理参数，我们探讨了不进行rFNAB进行患者管理的可能性。
确定了264例患者的275个结节，这些结节属于ND/UNS抽吸组，术后有明确的病理诊断。在这些参数的指导下，对进行和未进行rFNAB的患者进行了比较。
发现未进行rFNAB的结节的恶性发生率明显高于进行rFNAB的结节（p = 0.036）。此外，未进行rFNAB的BC-1结节的恶性发生率明显高于rFNAB结果也为BC-1的结节（p = 0.009）。在所有病例中，发现结节大小小于10 mm和边界不规则对恶性肿瘤具有统计学意义（p <0.020，p <0.002）。观察rFNAB结果的分布时，发现BC-4、5、6细胞学结果的患者中，女性性别、实性成分、低回声、边界不规则和结节周围晕环消失与之有显著相关性（分别为0.005 / 0.031 / 0.001 / 0.012 / 0.004）。
rFNAB在ND / UNS结节中未显示出预期效果。对于边界不规则、实性结构、晕环消失和低回声的结节，我们建议不进行rFNAB直接手术切除，这在女性患者中应被视为更重要。
