Meko J B, Norton J A
Department of Surgery, Washington University School of Medicine, St. Louis, Mo 63110, USA.
Surgery. 1995 Dec;118(6):996-1003; discussion 1003-4. doi: 10.1016/s0039-6060(05)80105-9.
False-negative fine-needle aspiration (FNA) biopsy results of thyroid nodules are of particular concern because they imply missed malignant lesions. The purpose of this study was to identify characteristics of thyroid nodules that may lead to false-negative cytologic interpretation after FNA.
We reviewed 90 consecutive patients who underwent preoperative FNA of thyroid nodules followed by thyroid surgery during a period of 27 months, including their clinical data, type and size of thyroid nodule, FNA cytology results, and final pathology report of the surgical specimen.
Thyroid nodules that had the highest probability of malignancy were those that were large (3 cm or larger), cystic/solid, or large and cystic/solid. The overall false-negative rate for preoperative FNA was 11%. Large, cystic/solid, and thyroid nodules with both characteristics had false-negative rates of 17%, 25%, and 30%, respectively, compared with 0%, 9%, and 17% for small (less than 3 cm), solid, and solid nodules 3 cm or larger, respectively.
Because of the high prevalence of malignancy in thyroid nodules that are large (3 cm or larger), cystic/solid, or large and cystic/solid and the high false-negative rate of FNA in diagnosing these lesions, thyroid lobectomy for diagnosis should be strongly considered in these patients even when FNA cytologic finding is interpreted as benign.
甲状腺结节细针穿刺（FNA）活检结果出现假阴性尤其令人担忧，因为这意味着可能漏诊恶性病变。本研究的目的是确定甲状腺结节的特征，这些特征可能导致FNA后细胞学解释出现假阴性。
我们回顾了连续90例患者，他们在27个月内接受了甲状腺结节术前FNA，随后进行了甲状腺手术，包括他们的临床资料、甲状腺结节的类型和大小、FNA细胞学结果以及手术标本的最终病理报告。
恶性可能性最高的甲状腺结节是那些大的（3厘米或更大）、囊实性或大且囊实性的结节。术前FNA的总体假阴性率为11%。大的、囊实性的以及兼具这两种特征的甲状腺结节的假阴性率分别为17%、25%和30%，而小的（小于3厘米）、实性的以及3厘米或更大的实性结节的假阴性率分别为0%、9%和17%。
由于大的（3厘米或更大）、囊实性或大且囊实性的甲状腺结节中恶性病变的发生率较高，且FNA诊断这些病变的假阴性率较高，即使FNA细胞学结果被解释为良性，对于这些患者也应强烈考虑行甲状腺叶切除术以明确诊断。
