Gardner H A, Ducatman B S, Wang H H
Department of Pathology, Beth Israel Hospital, Boston, Massachusetts 02215.
Cancer. 1993 Apr 15;71(8):2598-603. doi: 10.1002/1097-0142(19930415)71:8<2598::aid-cncr2820710826>3.0.co;2-f.
Fine-needle aspiration has been less valuable in the diagnosis of follicular lesions than for other neoplasms of the thyroid. It has been observed that follicular carcinoma is found in microfollicular, but not macrofollicular lesions, and this has served as a guide to management for many surgeons. The authors attempted to determine what cytologic parameters might usefully distinguish these types of follicular lesion.
The histologic findings and cytology of 56 thyroid lobectomies for follicular lesions that had adequate preoperative fine-needle aspiration of the thyroid (FNAT) were reviewed. Histologic specimens were classified into macrofollicular, mixed, and microfollicular groups. Cytologic features examined included the presence of colloid, irregularity of cell arrangements within groups, the presence and size of flat and folded cell sheets, three-dimensional clusters, and microfollicles and macrofollicles.
Of the histologic specimens, 15 were preponderantly (> 70%) microfollicular, 19 were mixed, and 22 were predominantly (> 70%) macrofollicular. Three cytologic features were useful in their distinction: none of the predominantly microfollicular but 24% of the mixed and predominantly macrofollicular had abundant colloid (P = 0.048). Likewise, none of the predominantly microfollicular but 27% of the mixed and predominantly macrofollicular had large follicles (P = 0.026). Finally, 73% of the predominantly microfollicular but only 37% of the mixed and predominantly macrofollicular showed irregularity or crowding of cells in groups (P = 0.018).
Used in combination, abundant colloid, regular spacing, and large follicles are helpful in distinguishing macrofollicular and mixed lesions from microfollicular ones, which have a higher malignant potential.
细针穿刺在滤泡性病变诊断中的价值低于其在甲状腺其他肿瘤诊断中的价值。据观察，滤泡癌见于微滤泡性病变而非大滤泡性病变，这已成为许多外科医生的治疗指南。作者试图确定哪些细胞学参数可能有助于区分这些类型的滤泡性病变。
回顾了56例因滤泡性病变行甲状腺叶切除术患者的组织学检查结果及术前甲状腺细针穿刺抽吸术（FNAT）充分的细胞学检查结果。组织学标本分为大滤泡性、混合性和微滤泡性组。检查的细胞学特征包括胶体的存在、细胞排列的不规则性、扁平及折叠细胞片的存在及大小、三维细胞团以及微滤泡和大滤泡。
在组织学标本中，15例以微滤泡为主（>70%），19例为混合性，22例以大滤泡为主（>70%）。有三个细胞学特征有助于区分它们：以微滤泡为主的标本中无一例有丰富胶体，而混合性及以大滤泡为主的标本中有24%有丰富胶体（P = 0.048）。同样，以微滤泡为主的标本中无一例有大滤泡，而混合性及以大滤泡为主的标本中有27%有大滤泡（P = 0.026）。最后，以微滤泡为主的标本中有73%显示细胞排列不规则或拥挤，而混合性及以大滤泡为主的标本中只有37%显示如此（P = 0.018）。
丰富的胶体、规则的间距和大滤泡结合起来有助于区分大滤泡性和混合性病变与微滤泡性病变，后者具有较高的恶性潜能。
