Kini S R, Miller J M, Hamburger J I, Smith-Purslow M J
Diagn Cytopathol. 1985 Apr-Jun;1(2):123-32. doi: 10.1002/dc.2840010208.
Fine needle biopsy is generally considered unreliable in the differential diagnosis of follicular lesions of the thyroid gland. To test this hypothesis, we correlated fine needle biopsy diagnoses with surgical diagnoses in 379 follicular lesions. From nuclear characteristics (especially size) and the architectural pattern of tissue fragments, the following observations were made. Differentiation of goiters (including hyperplastic ones) from neoplastic thyroid disease is quite accurate and no more than 1 to 2% of cancers should be missed. The specific cytologic diagnosis of follicular carcinoma is 75% accurate, and that of follicular variant of papillary carcinoma is over 95% accurate. Of histologically proved follicular carcinomas, almost three-quarters should be diagnosed as such or strongly suspected by fine needle biopsy. The remainder will be identified as cellular follicular adenomas, reaffirming the overlap of cytologic features of benign and malignant neoplastic disease. From cytologic and surgical pathologic data for each fine needle biopsy diagnosis of follicular lesion, a probability of cancer can be stated that is useful in management decisions.
细针穿刺活检通常被认为在甲状腺滤泡性病变的鉴别诊断中不可靠。为了验证这一假设，我们将379例滤泡性病变的细针穿刺活检诊断结果与手术诊断结果进行了对比。从细胞核特征（尤其是大小）和组织碎片的结构模式方面，得出了以下观察结果。甲状腺肿（包括增生性甲状腺肿）与甲状腺肿瘤性疾病的鉴别诊断相当准确，漏诊的癌症不超过1%至2%。滤泡癌的特异性细胞学诊断准确率为75%，乳头状癌滤泡变体的诊断准确率超过95%。在组织学证实的滤泡癌中，近四分之三的病例通过细针穿刺活检应能做出此类诊断或被高度怀疑。其余病例将被诊断为细胞性滤泡性腺瘤，这再次证实了良性和恶性肿瘤性疾病在细胞学特征上的重叠。根据每个滤泡性病变细针穿刺活检诊断的细胞学和手术病理数据，可以得出一个癌症概率，这对治疗决策很有用。
