de Micco C
Faculté de Médecine Nord, Laboratoire d'Anatomie Pathologique, Marseille.
Ann Endocrinol (Paris). 1993;54(4):258-63.
For the majority of centres worldwide that specialize in the treatment of thyroid diseases, cytology is now the first investigation carried out in patients with thyroid nodules. Procedures and expected results of this examination are described, together with the progress accomplished by immunocytochemical detection of malignancy markers such as thyroid peroxidase (TPO). Puncture biopsy is preferably by fine needle aspiration, the quality of the examination depending essentially on the quality of the specimen and the cytologist's experience. Results are recorded as benign (colloid nodules and thyroiditis), intermediate (microfollicular tumors, doubtful lesions) and malignant (follicular, papillary, anaplastic and medullary carcinomas). In experienced hands, the average sensitivity of the examination for cancer detection is 90 to 95% and its specificity 65 to 75%. These limits result from a non significant level of sampling of 10 to 20% and the persistence of 2 to 5% of false negatives, independent of the cytologist's expertise. Based on results of an ongoing cohort study comprising at present 300 histologically controlled cases, immunodetection of TPO in puncture biopsy specimens using MAb 47 antibodies could result in a sensitivity of about 100% for a specificity of more than 90%.
对于全球大多数专门治疗甲状腺疾病的中心而言，细胞学检查如今是甲状腺结节患者首先进行的检查。本文描述了该检查的操作步骤和预期结果，以及通过免疫细胞化学检测甲状腺过氧化物酶（TPO）等恶性标志物所取得的进展。穿刺活检最好采用细针穿刺抽吸，检查质量主要取决于标本质量和细胞学家的经验。结果记录为良性（胶样结节和甲状腺炎）、中间性（微滤泡肿瘤、可疑病变）和恶性（滤泡癌、乳头状癌、未分化癌和髓样癌）。在经验丰富的医生手中，该检查对癌症检测的平均敏感性为90%至95%，特异性为65%至75%。这些局限性源于10%至20%的非显著抽样水平以及2%至5%的假阴性持续存在，与细胞学家的专业水平无关。基于一项正在进行的队列研究结果（目前包括300例经组织学对照的病例），使用单克隆抗体47在穿刺活检标本中对TPO进行免疫检测，敏感性约为100%，特异性超过90%。
