Tyler D S, Winchester D J, Caraway N P, Hickey R C, Evans D B
Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Surgery. 1994 Dec;116(6):1054-60.
We examined the various cytologic features of indeterminate thyroid fine-needle aspirates along with known clinical and radiologic risk factors to determine whether any parameters were predictive of malignancy.
Indeterminate fine-needle aspirates were prospectively categorized into four subgroups: (1) suspicious for papillary carcinoma, (2) follicular neoplasm, (3) Hürthle cell neoplasm, and (4) hypercellular follicular aspirates with colloid. Several clinical risk factors were examined, and subgroup comparisons were performed with Fisher's exact test.
Of 571 fine-needle aspirate cytologic findings 104 were interpreted as indeterminate for malignancy, and 81 patients underwent thyroidectomy. Invasive cancer was diagnosed in 9 of 10 lesions cytologically suspicious for papillary carcinoma, 8 of 43 follicular neoplasms, 5 of 18 Hürthle cell neoplasms, and 0 of 10 hypercellular aspirates. Cytologic subgroup (p < 0.0001) and age of 50 years or older (p = 0.008) were the only significant predictors of malignancy. When used together, age of 50 years or older and a cytologic diagnosis of follicular or Hürthle cell neoplasm also identified a subgroup of patients at high risk (9 of 20) of invasive malignancy (p = 0.01).
The majority of invasive cancers (18 of 22, 82%) were found in patients whose lesions were suspicious for papillary carcinoma or in patients 50 years or older with follicular or Hürthle cell neoplasms. The risk of carcinoma in these combined subgroups (18 of 30, 60%) warrants early surgical intervention.
我们研究了甲状腺细针穿刺结果不确定的各种细胞学特征，并结合已知的临床和放射学风险因素，以确定是否有任何参数可预测恶性肿瘤。
将甲状腺细针穿刺结果不确定的病例前瞻性地分为四个亚组：（1）可疑乳头状癌；（2）滤泡性肿瘤；（3）许特莱细胞肿瘤；（4）富含细胞的滤泡性穿刺伴胶体。研究了几个临床风险因素，并采用Fisher精确检验进行亚组比较。
在571例细针穿刺细胞学检查结果中，104例被判定为恶性不确定，81例患者接受了甲状腺切除术。在细胞学上可疑为乳头状癌的10个病变中，有9个诊断为浸润性癌；43个滤泡性肿瘤中有8个；18个许特莱细胞肿瘤中有5个；10个富含细胞的穿刺样本中无一例。细胞学亚组（p < 0.0001）和年龄50岁及以上（p = 0.008）是仅有的显著恶性肿瘤预测因素。年龄50岁及以上且细胞学诊断为滤泡性或许特莱细胞肿瘤的患者，也构成了一个浸润性恶性肿瘤高风险亚组（20例中有9例，p = 0.01）。
大多数浸润性癌（22例中有18例，82%）见于病变可疑为乳头状癌的患者，或年龄50岁及以上的滤泡性或许特莱细胞肿瘤患者。这些联合亚组中的癌症风险（30例中有18例，60%）需要早期手术干预。
