Staubitz Julia I, Poplawski Alicia, Watzka Felix, Musholt Thomas J
Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
Institute for Medical Biometry, Epidemiology and Informatics, University Medical Centre Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
Innov Surg Sci. 2021 Aug 17;7(3-4):99-106. doi: 10.1515/iss-2021-0004. eCollection 2022 Dec.
Fine-needle aspiration cytology (FNAC) is recommended by international guidelines for the preoperative evaluation of suspicious thyroid nodules >1 cm. Despite robust evidence from endocrine centers demonstrating the key role of FNAC results for the indication of surgery, the method is not routinely used in European clinics. The database EUROCRINE, which was introduced in 2015 with the scope of registering operations of the endocrine system, allows for a large-scale analysis of the current service reality in Europe concerning FNAC use and associated accuracy.
Operations performed to "exclude malignancy", registered from January 2015 to December 2018 in EUROCRINE, were analyzed. Parameters of accuracy were calculated for FNAC. FNAC results were considered "test positive" in the case of Bethesda category IV, V, and VI, since these categories usually prompt surgical interventions in European centers for thyroid surgery. Bethesda category II and III were considered "test negative".
Of 8,791 operations, 5,780 had preoperative FNAC (65.7%). The overall malignancy rate was 28.3% (2,488/8,791). Malignancy rates were 68.8% for Bethesda VI, 69.9% for Bethesda V, 32.6% for Bethesda IV, 28.2% for III, 20.2% for Bethesda II, and 24.5% for Bethesda I. After exclusion of papillary microcarcinomas (PTMCs), the sensitivity of FNAC was 71.7% and specificity 43.5%, the positive predictive value was 29.1% and the negative predictive value 82.7%.
Although the indication to "exclude malignancy" was the predominant reason that prompted thyroid resection in the present cohort, FNAC was only used in about 65.7% of cases. When performed, FNAC was associated with unexpectedly low accuracy. Interestingly, in Bethesda II, 20.2% of malignant entities were present (13.3% after the exclusion of PTMCs).
国际指南推荐对直径大于1厘米的可疑甲状腺结节进行术前评估时采用细针穿刺细胞学检查（FNAC）。尽管内分泌中心有充分证据表明FNAC结果对手术指征具有关键作用，但该方法在欧洲诊所并未常规使用。2015年引入的EUROCRINE数据库旨在记录内分泌系统手术，可对欧洲目前关于FNAC使用情况及相关准确性的服务现状进行大规模分析。
分析2015年1月至2018年12月在EUROCRINE中登记的为“排除恶性肿瘤”而进行的手术。计算FNAC的准确性参数。在贝塞斯达分类为IV、V和VI的情况下，FNAC结果被视为“检测阳性”，因为在欧洲甲状腺手术中心，这些分类通常会促使进行手术干预。贝塞斯达分类II和III被视为“检测阴性”。
在8791例手术中，5780例进行了术前FNAC（65.7%）。总体恶性率为28.3%（2488/8791）。贝塞斯达VI类的恶性率为68.8%，贝塞斯达V类为69.9%，贝塞斯达IV类为32.6%，III类为28.2%，贝塞斯达II类为20.2%，贝塞斯达I类为24.5%。排除微小乳头状癌（PTMC）后，FNAC的敏感性为71.7%，特异性为43.5%，阳性预测值为29.1%，阴性预测值为82.7%。
尽管在本队列中“排除恶性肿瘤”的指征是促使进行甲状腺切除的主要原因，但FNAC仅在约65.7%的病例中使用。当进行FNAC时，其准确性意外地低。有趣的是，在贝塞斯达II类中，存在20.2%的恶性实体（排除PTMC后为13.3%）。
