Histologic and clinical follow-up of thyroid fine-needle aspirates in pediatric patients.
小儿患者甲状腺细针穿刺的组织学诊断和临床随访
Abstract
Although fine-needle aspiration (FNA) has an important role in evaluating thyroid nodules in adults, there is little published information regarding its utility in the pediatric population.
A retrospective analysis of thyroid FNAs for patients who were 18 years old or younger at 2 institutions was conducted. Aspirates were retrospectively categorized with the Bethesda System for Reporting Thyroid Cytopathology. These diagnoses were then correlated with either final histopathology or clinical follow-up.
A total of 186 thyroid FNA samples from 154 patients (122 females and 32 males), who ranged in age from 9 months to 18 years (median, 16 years; mean, 14 years), were identified. FNA was performed to evaluate 1 to 3 nodules for each patient. Aspirates were classified as follows: nondiagnostic (n = 27), benign (n = 114), atypia of undetermined significance (AUS; n = 21), follicular neoplasm (FN; n = 8), suspicious for malignancy (n = 3), and malignant (n = 13). Sixty-one samples had a histologic correlation, 68 were followed clinically for ≥2 years, and 57 either had no follow-up or were followed for <2 years. For statistical purposes, FNA diagnoses of suspicious and malignant were considered positive, and benign lesions were considered negative. The accuracy was 99%, and the sensitivity and specificity were 94% and 100%, respectively. The risk of malignancy, not including papillary microcarcinoma, was 2% for benign aspirates, 21% for AUS, 57% for FN, and 100% for suspicious or malignant aspirates.
This analysis demonstrates that FNA is a sensitive and highly specific modality for evaluating thyroid nodules in pediatric patients. Each diagnostic category can facilitate communication and guide appropriate management. Cancer Cytopathol 2016;124:467-71. © 2016 American Cancer Society.
A retrospective analysis of thyroid FNAs for patients who were 18 years old or younger at 2 institutions was conducted. Aspirates were retrospectively categorized with the Bethesda System for Reporting Thyroid Cytopathology. These diagnoses were then correlated with either final histopathology or clinical follow-up.
A total of 186 thyroid FNA samples from 154 patients (122 females and 32 males), who ranged in age from 9 months to 18 years (median, 16 years; mean, 14 years), were identified. FNA was performed to evaluate 1 to 3 nodules for each patient. Aspirates were classified as follows: nondiagnostic (n = 27), benign (n = 114), atypia of undetermined significance (AUS; n = 21), follicular neoplasm (FN; n = 8), suspicious for malignancy (n = 3), and malignant (n = 13). Sixty-one samples had a histologic correlation, 68 were followed clinically for ≥2 years, and 57 either had no follow-up or were followed for <2 years. For statistical purposes, FNA diagnoses of suspicious and malignant were considered positive, and benign lesions were considered negative. The accuracy was 99%, and the sensitivity and specificity were 94% and 100%, respectively. The risk of malignancy, not including papillary microcarcinoma, was 2% for benign aspirates, 21% for AUS, 57% for FN, and 100% for suspicious or malignant aspirates.
This analysis demonstrates that FNA is a sensitive and highly specific modality for evaluating thyroid nodules in pediatric patients. Each diagnostic category can facilitate communication and guide appropriate management. Cancer Cytopathol 2016;124:467-71. © 2016 American Cancer Society.
摘要
尽管细针穿刺（FNA）在评估成人甲状腺结节中扮演了重要的角色，但几乎没有其在小儿患者中效用的信息发表。
针对来自2个机构的18岁及以下患者甲状腺细针穿刺做回顾性研究。穿刺标本按照甲状腺细胞病理学Bethesda报告系统进行分类。穿刺诊断与最终组织学诊断或临床随访进行比较。
来自154个患者（男性122人、女性32人）共186例甲状腺细针穿刺样本，年龄范围自9个月至18岁（中位年龄16岁，平均年龄14岁）。每个患者细针穿刺1到3个结节。穿刺标本分为6级：无诊断价值（n=27）、良性（n=114）、意义不明的不典型增生（AUS；n=21）、滤泡性肿瘤（FN；n=8）、怀疑恶性（n=3）和恶性（n=13）。61例样本与组织学诊断一致，68例临床随访超过2年，57例未随访或随访时间短于2年。按照统计学目的将FNA诊断结果中怀疑恶性和恶性的定为阳性，良性定为阴性。准确性为99%，敏感性与特异性分别为94%和100%。恶性（除外甲状腺微小乳头状癌）风险为：良性约为2%、AUS约为21%、FN约为57%，怀疑恶性或恶性为100%。
分析表明，FNA是小儿甲状腺结节评估中一种敏感且有较高特异性的方法。进行诊断分类不但方便沟通，而且可以指导准确治疗。
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