Caraway N P, Sneige N, Samaan N A
Department of Pathology, University of Texas, M. D. Anderson Cancer Center, Houston 77030.
Diagn Cytopathol. 1993;9(3):345-50. doi: 10.1002/dc.2840090320.
To determine the diagnostic pitfalls of thyroid fine-needle aspiration (FNA), we reviewed 394 thyroid aspirates obtained between January 1986 and December 1990. Surgical follow-up was available for 150 aspirations. The cytologic diagnoses were categorized into four groups: benign, 57; indeterminate, 51; malignant, 33; and nondiagnostic specimen, nine. There were three false negative diagnoses (3%), which upon review were judged to be inadequate specimens. Three false positive diagnoses (7%) were identified: in the first two cases, follicular adenomas were mistaken for papillary carcinoma; in the third case, atypical Hürthle cells were mistaken for a Hürthle cell carcinoma. Our results showed a sensitivity of 93% and a specificity of 91% for the detection of malignancy. If indeterminate cases were considered positive, the specificity decreased to 50%, while the sensitivity increased to 97%. We conclude that: 1) certain follicular adenomas may display cytologic features mimicking papillary carcinoma; 2) as in follicular neoplasms, aspirates of Hürthle cell adenomas cannot be differentiated from Hürthle cell carcinomas; 3) with adequate sampling, false negative results can be markedly reduced.
为确定甲状腺细针穿刺活检（FNA）的诊断陷阱，我们回顾了1986年1月至1990年12月间获取的394份甲状腺穿刺样本。其中150份样本有手术随访结果。细胞诊断分为四组：良性57例；不确定51例；恶性33例；非诊断性样本9例。有3例假阴性诊断（3%），复查后判定为样本不充分。发现3例假阳性诊断（7%）：前两例中，滤泡性腺瘤被误诊为乳头状癌；第三例中，非典型许特莱细胞被误诊为许特莱细胞癌。我们的结果显示，检测恶性肿瘤的敏感性为93%，特异性为91%。如果将不确定病例视为阳性，则特异性降至50%，而敏感性升至97%。我们得出以下结论：1）某些滤泡性腺瘤可能表现出类似乳头状癌的细胞特征；2）与滤泡性肿瘤一样，许特莱细胞腺瘤的穿刺样本无法与许特莱细胞癌相区分；3）通过充分取样，可显著减少假阴性结果。
