Kwon Hyuk, Lee Jandee, Hong Soon Won, Kwon Hyeong Ju, Kwak Jin Young, Yoon Jung Hyun
Taehan Yongsang Uihakhoe Chi. 2022 May;83(3):645-657. doi: 10.3348/jksr.2021.0125. Epub 2021 Dec 23.
To evaluate and compare the diagnostic outcomes of ultrasonography (US)-guided fine needle aspiration (FNA) and core needle biopsy (CNB) performed on the same thyroid nodule using a surgical specimen for direct comparison.
We included 89 thyroid nodules from 88 patients from February 2015 to January 2016. The inclusion criterion was thyroid nodules measuring ≥ 20 mm (mean size: 40.0 ± 15.3 mm). Immediately after surgical resection, FNA and subsequent CNB were performed on the surgical specimen under US guidance. FNA and CNB cytopathologic results on the specimen were compared with the surgical diagnosis.
Among the 89 nodules, 30 were malignant and 59 were benign. Significantly higher inconclusive rates were seen in FNA for malignant than benign nodules (80.0% vs. 39.0%, < 0.001). For CNB, conclusive and inconclusive rates did not differ between benign and malignant nodules ( = 0.796). Higher inconclusive rates were seen for FNA among cancers regardless of US features, and in the subgroup of size ≥ 40 mm (62.5% vs. 22.9%, = 0.028). Eleven cancers were diagnosed with CNB (36.7%, 11/30), while none was diagnosed using FNA.
In this experimental study using surgical specimens, CNB showed a potential to provide improved diagnostic sensitivity for thyroid cancer, especially when a conclusive diagnosis is limited with FNA.
通过使用手术标本进行直接比较，评估和比较超声（US）引导下对同一甲状腺结节进行细针穿刺抽吸（FNA）和粗针活检（CNB）的诊断结果。
我们纳入了2015年2月至2016年1月期间88例患者的89个甲状腺结节。纳入标准为甲状腺结节直径≥20mm（平均大小：40.0±15.3mm）。手术切除后立即在超声引导下对手术标本进行FNA及随后的CNB。将标本的FNA和CNB细胞病理学结果与手术诊断结果进行比较。
在89个结节中，30个为恶性，59个为良性。FNA对恶性结节的不确定率显著高于良性结节（80.0%对39.0%，<0.001）。对于CNB，良性和恶性结节的确诊率和不确定率无差异（=0.796）。无论超声特征如何，FNA在癌症中的不确定率更高，在大小≥40mm的亚组中也是如此（62.5%对22.9%，=0.028）。11例癌症通过CNB诊断（36.7%，11/30），而FNA未诊断出任何癌症。
在这项使用手术标本的实验研究中，CNB显示出对甲状腺癌提高诊断敏感性的潜力，尤其是在FNA难以做出确定性诊断时。
