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Title: [The effect of Hashimoto's thyroiditis on the diagnostic efficacy of ultrasound-guided fine needle aspiration cytology for thyroid nodules ≥ 1 cm].
Author: Hou J, Li M, Peng X, Li Y, Liu L.
Journal: Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2021 Sep; 35(9):807-812. PubMed ID: 34628833.
Abstract:
Objective:To explore the diagnostic efficacy of ultrasound-guided fine needle aspiration cytology（US-FNAC） for thyroid nodules ≥1 cm, and the effect of Hashimoto's thyroiditis（HT） on it. Methods:The clinical data of 1027 cases of thyroid nodules ≥ 1 cm were retrospectively analyzed. Two-dimensional ultrasound, US-FNAC and BRAFV600E gene testing were performed. The postoperative pathological results were used as the criterion. The two dimensional ultrasound examination, clinical characteristics, follow-up results, and BRAFV600E were used to diagnosis for unoperated patients. The diagnostic efficiency of US-FNAC in HT（+） group and HT（-） group was compared, and the factors affecting the diagnostic efficiency were analyzed. Results:Of the 1027 nodules, the cytological results were nondiagnostic/unsatisfactory in 73 nodules（7.1%）, benign in 282（27.5%）, atypia of undetermined significance/follicular lesion of undetermined significance in 230（22.4%）, follicular neoplasm/suspicious for a follicular neoplasm in 20（1.9%）, suspicious for malignancy in 120（11.7%）, and malignant in 302（29.4%）. 515 cases underwent surgery. Among them, 495 were malignant and 20 were benign. 512 cases continued to be followed up without surgery, and the BRAFV600E of them were wild type. Combined with the two dimensional ultrasound examination, clinical features, and follow-up results, they were judged to be benign. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and the false negative rate the of US-FNAC were 98.7%, 98.4%, 99.3%, 99.5%, 97.5%, 0.7% and 1.6%, respectively. The accuracy, sensitivity and negative predictive value of the HT（+） group were 95.5%, 95.4% and 82.8%, respectively, which were lower than that of HT（-） group （99.5%, 99.4%, 99.2% ）（P=0.001, 0.018, P<0.001）. The false negative rate of the HT（+） group was 4.6%, higher than 0.6% of the HT（-） group（P=0.018）, and HT was an risk factor for increased FNR（OR=7.596, 95%CI: 1.452-39.740）. Conclusion:US-FNAC is an effective method for the diagnosis of thyroid nodules and it has high sensitivity and specificity in ≥ 1 cm nodules. However, the combination of HT reduces the diagnostic accuracy and HT is a risk factor for increased false negative rate. 目的：探讨超声引导下细针穿刺细胞学检查（US-FNAC）对≥1 cm甲状腺结节的诊断效能，及合并桥本甲状腺炎（HT）对诊断效能的影响。 方法：回顾性分析1027例≥1 cm行US-FNAC的甲状腺结节患者的临床资料，所有患者均行二维超声检查及BRAFV600E基因检测，并对其进行随访，手术者以术后病理结果为判定标准，未手术者结合二维超声检查、临床特征、随访结果及BRAFV600E判定，比较HT（+）组与HT（-）组US-FNAC诊断效能，分析影响诊断效能的因素。 结果：1027例结节中，无法诊断或标本不满意73例（7.1%），良性282例（27.5%），意义不明确的细胞非典型病变或意义不明确的滤泡病变230例（22.4%），滤泡肿瘤或可疑的滤泡肿瘤20例（1.9%），可疑恶性肿瘤120例（11.7%），恶性302例（29.4%）。515例行结节手术，其中恶性肿瘤495例，良性20例；512例未手术继续随访，均为BRAFV600E野生型，结合二维超声检查、临床特征、随访结果，判定其为良性。US-FNAC的准确度、灵敏度、特异度、阳性预测值、阴性预测值、假阳性率和假阴性率分别为98.7%、98.4%、99.3%、99.5%、97.5%、0.7%和1.6%。HT（+）组的准确度、灵敏度、阴性预测值分别为95.5%、95.4%、82.8%，低于HT（-）组的99.5%、99.4%、99.2%（P=0.001、0.018及P<0.001），HT（+）组的假阴性率（4.6%）高于HT（-）组（0.6%）（P=0.018），且HT为假阴性率升高的危险因素（OR=7.596，95%CI：1.452～39.740）。 结论：US-FNAC是甲状腺结节诊断的有效手段，在≥1 cm结节中，灵敏度和特异度高，但合并HT降低了诊断准确度，且HT为假阴性率升高的危险因素。.

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