细胞学不确定的甲状腺结节恶性肿瘤的发生率和临床预测因素

Feron Getachew Tefera
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摘要

背景:细针穿刺细胞学(FNAC)不能区分细胞学上不确定的甲状腺病变的良恶性。因此,最低限度的诊断性肺叶切除术是需要明确的诊断。本研究的目的是确定在埃塞俄比亚医院中可能预测这些病变患者恶性肿瘤的恶性率和临床特征。方法:回顾性分析2015年9月至2020年9月在三家转诊医院接受甲状腺细胞学不确定病变手术的患者的医疗记录。结果:85例细胞学检查结果不确定的患者中,56例(63.5%)为滤泡性肿瘤,29例(34.1%)为hurthle细胞肿瘤。未确定意义的滤泡性病变(FLUS)和疑似滤泡性肿瘤的病例均为单个病例(1.7%)。恶性疾病19例(22.4%)。7例(11.5%)患者检出滤泡型乳头状癌。11例恶性病变中有9例出现硬结节一致性,66例良性病变中有5例。在多元二元logistic回归中,发现硬结节一致性与恶性肿瘤相关(P = 0.012, AOR = 7.28 (1.5, 34.54) 95% CI)。结节表面轮廓不清与恶性肿瘤相关,但相关性无统计学意义(P = 0.088, AOR = 0.162 (0.020, 1.313) 95% CI。超声检查甲状腺结节仅41例(47.7%)。结论:细胞学不确定的甲状腺结节的恶性率为22.4%。甲状腺结节硬度高、结节表面不清晰者发生恶性肿瘤的风险较高。尽管超声对甲状腺结节的评估有既定的好处,但目前在我们的设置中使用它的实践是次优的。关键词:滤泡;许特耳氏细胞;不确定的细胞学;恶性肿瘤的预测因子
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rate and Clinical Predictors of Malignancy in Thyroid Nodules with Indeterminate Cytology
Background: Fine needle aspiration cytology (FNAC) cannot differentiate between benign and malignant conditions in cytologically indeterminate thyroid lesions. Therefore, a minimum of diagnostic lobectomy is required for definitive diagnosis. The objective of this study is to identify the rate of malignancy and clinical features that may possibly predict malignancy in patients with these lesions, in Ethiopian hospitals. Methods: This was a retrospective review of the medical records of patients who underwent surgery for cytologically indeterminate thyroid lesions in three referral hospitals between September 2015 and September 2020. Results: Of 85 patients with indeterminate cytology findings, 56 (63.5%) were follicular, and 29 (34.1%) were reported to be hurthle cell neoplasms. Follicular lesions of undetermined significance (FLUS) and suspicious for follicular neoplasm were each reported in single cases (1.7%). Malignant disease was diagnosed in 19 (22.4%) of patients. A follicular variant of papillary cancer was detected in 7 (11.5%) patients. Hard nodule consistency was reported in 9 of 11 malignant lesions and 5 of 66 benign lesions. In multivariate binary logistic regression, hard nodule consistency was found to be associated with malignancy (P = 0.012, AOR = 7.28 (1.5, 34.54) 95% CI ). The ill-defined surface of a nodule was found to be associated with malignancy though the association was not statistically significant (P = 0.088, AOR = 0.162 (0.020, 1.313) 95% CI. Ultrasound evaluation of thyroid nodule was performed only in 41 (47.7%) of patients. Conclusion: The rate of malignancy in thyroid nodules with indeterminate cytology was 22.4%. The risk of malignancy was higher in patients with hard thyroid nodule consistency and ill-defined surface. Despite the established benefits of ultrasound for the evaluation of thyroid nodules, the current practice of its use in our setup is suboptimal. Keywords: Follicular; hurthle cell; indeterminate cytology; predictors of malignancy
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