Burch H B, Burman K D, Reed H L, Buckner L, Raber T, Ownbey J L
Department of Medicine, Walter Reed Army Medical Center, Washington, D.C. 20307-5001, USA.
Acta Cytol. 1996 Nov-Dec;40(6):1176-83. doi: 10.1159/000333977.
To evaluate patient- and practice-specific determinants of the thyroid nodule fine needle aspiration (FNA) insufficiency rate and malignancy yield at a tertiary-care teaching hospital.
All FNAs of thyroid nodules performed from August 1990 to October 1993 at the Walter Reed Army Medical Center Endocrinology Clinic were reviewed and the results analyzed for correlation with surgical outcome, scintiscanning result and operator experience. Provider-specific factors influencing the FNA insufficiency rate, surgical referral pattern and malignancy yield were evaluated.
A total of 504 aspirations in 422 patients with thyroid nodules were included in the analysis. The sensitivity of FNA for detecting malignancy was 80%, specificity was 73.2%, and accuracy was 75.2%. A significant negative correlation was found between recent aspirator experience and the insufficiency rate. Repeat aspiration of nodules previously yielding benign cytology increased the malignancy yield. Surgical excision of nodules with insufficient aspirations gave a low malignancy yield, and aspiration of nodules that were "hot" on scintiscanning rarely yielded false positive FNA results.
Specific limitations of thyroid nodule FNA include a large number of aspirates containing insufficient cytologic material and a variable malignancy yield. Specific recommendations based on the findings in this report are: the establishment of uniform criteria for judging specimen adequacy, the performance of repeat aspiration on thyroid nodules with previously benign aspirates, the abandonment of scintiscanning in the routine management of thyroid nodules and a conservative approach to clinically indolent nodules repeatedly found to have scant cellularity on FNA. Based on these findings, an algorithm for the diagnostic evaluation of a solid thyroid nodule can be constructed.
评估在一家三级护理教学医院中，患者及特定医疗实践因素对甲状腺结节细针穿刺活检（FNA）取材不足率及恶性病变检出率的影响。
回顾了1990年8月至1993年10月在沃尔特·里德陆军医疗中心内分泌科诊所进行的所有甲状腺结节FNA，并分析结果与手术结果、闪烁扫描结果及操作者经验的相关性。评估了影响FNA取材不足率、手术转诊模式及恶性病变检出率的医疗服务提供者特定因素。
分析纳入了422例甲状腺结节患者的504次穿刺活检。FNA检测恶性病变的敏感性为80%，特异性为73.2%，准确性为75.2%。发现近期穿刺操作者的经验与取材不足率之间存在显著负相关。对先前细胞学检查为良性的结节进行重复穿刺可提高恶性病变检出率。对取材不足的结节进行手术切除，恶性病变检出率较低，对闪烁扫描显示为“热”结节的穿刺活检很少出现FNA假阳性结果。
甲状腺结节FNA的特定局限性包括大量取材的细胞学材料不足以及恶性病变检出率存在差异。基于本报告结果的具体建议如下：建立判断标本充足性的统一标准，对先前穿刺为良性的甲状腺结节进行重复穿刺，在甲状腺结节的常规管理中放弃闪烁扫描，对FNA反复发现细胞数量稀少的临床惰性结节采取保守方法。基于这些发现，可构建一个实性甲状腺结节诊断评估的算法。
