针吸细胞学对甲状腺乳头状癌的诊断价值

目的探讨甲状腺乳头状癌的细针细胞学核的特征,提高甲状腺乳头状癌的诊断准确性。方法回顾性分析121例经组织学证实为甲状腺乳头状癌的细针穿刺细胞学标本。结果 121例中,细胞学诊断无法诊断或标本不满意3例,良性病变2例,非典型病变2例,滤泡性肿瘤2例,可疑乳头状癌12例,乳头状癌100例。核沟在甲状腺乳头状癌细胞学中阳性率最高,但其特异性不足。核内假包涵体、砂砾体在甲状腺乳头状癌的阳性率低于核沟,但特异性很高。结论超声引导下细针穿刺细胞学检查对甲状腺乳头状癌的诊断有较高的敏感性,核沟、核内假包涵体、砂砾体是诊断甲状腺乳头状癌的重要指标。     

细针穿刺细胞学检查在甲状腺癌诊断中的应用价值研究

目的:探讨细针穿刺细胞学检查在甲状腺癌诊断中的应用价值。方法:回顾性分析2014年8月~2016年8月在我院行细针穿刺细胞学检查的80例甲状腺结节患者的检查结果,并与手术后组织病理学结果进行对比。结果:细针穿刺细胞学诊断甲状腺良恶性结节性质的敏感度为91.38%(53/58),特异性为86.36%(19/22),阴性预测值为79.17%(19/24),阳性预测值为94.64%(53/56),准确度为90.00%(72/80)。细针穿刺细胞学和组织病理学诊断中:甲状腺肿的诊断符合率为97.14%,甲状腺腺瘤诊断符合率为93.33%,甲状腺癌诊断符合率为76.00%,桥本氏甲状腺炎诊断符合率为100%。结论:细针穿刺细胞学检查对甲状腺癌诊断的敏感性、特异性和准确度均较高,与组织病理学诊断符合率较好,可作为有效的术前确诊手段。     

超声引导下甲状腺细针穿刺细胞学检查及液基薄层细胞学在甲状腺疾病诊断中的应用价值

目的探讨超声引导下甲状腺细针穿刺细胞学及液基薄层细胞学对甲状腺疾病诊断的临床应用价值。方法选择78例甲状腺结节患者,其中男性34例,女性44例;年龄33~64岁,平均年龄47.6岁。对甲状腺结节患者行细针穿刺活组织检查,观察细胞病理学与组织病理学诊断结果。结果 78例患者均获取足够的标本,其中73例(93.6%)细胞学结果与病理学诊断结果一致,即20例(25.6%)为恶性肿瘤,44例(56.4%)为良性肿瘤,9例(11.5%)为非肿瘤性病变。甲状腺细针穿刺鉴别甲状腺结节良恶性的灵敏度为90.9%,特异度为98.1%。阳性预测值为96.3%。结论超声引导下甲状腺细针穿刺细胞学检查及液基薄层细胞学检查在甲状腺疾病诊断中有诊断性的临床应用价值,与组织病理学检查总体诊断符合率较好。该方法为是否采取手术治疗及术式的选择提供了有力的依据,是一种安全、有效的术前确诊手段。     

甲状腺乳头状癌细针穿刺涂片中BRAF(VE1)的表达及其临床意义

目的探讨甲状腺细针穿刺涂片免疫细胞化学染色与甲状腺乳头状癌颈部淋巴结转移和多灶性发生之间的关系。方法收集甲状腺细针穿刺涂片诊断为甲状腺乳头状癌或可疑甲状腺乳头状癌合计89例,记录其手术标本中的病灶数量及是否淋巴结转移,细胞涂片褪色后行BRAF(VE1)免疫细胞化学染色,对染色结果与淋巴结转移及肿瘤多灶性的关系进行分析。结果 89例涂片中检出BRAF阳性51例,阴性38例。BRAF阳性组与阴性组间淋巴结转移率差异有显著性(χ~2=47.352,P0.05),一致性检验κ值为0.733;BRAF阳性组与阴性组间多灶性发生率差异有显著性(χ~2=19.177,P0.05),一致性检验κ值为0.445。结论甲状腺细针穿刺涂片BRAF免疫细胞化学染色对甲状腺乳头状癌颈部淋巴结转移和肿瘤多灶性发生具有一定的预测价值,有望成为术前评估淋巴结转移风险的指标。     

Galectin-3与CD44v6检测运用于甲状腺癌鉴别诊断中的价值

目的 研究Galectin-3与CD44v6检测在甲状腺癌鉴别诊断中的价值.方法 收集2015年2月至2016年9月我院病理科收集的细针穿刺细胞学标本125例.其中甲状腺癌标本48例,甲状腺良性结节标本41例,另有病变旁正常甲状腺组织36例.分别采用免疫组化法检测不同组织中Galectin-3与CD44v6的表达,并进行对比.此外,比较良恶性甲状腺结节患者的年龄、性别、甲状腺家族史、辐射暴露以及碘摄入情况,并作多因素Logistics回归分析.结果 甲状腺癌组织中Galectin-3与CD44v6的表达阳性率分别为81.25%(39/48)、72.92%(35/48),均高于正常甲状腺组织与甲状腺良性结节,且差异有统计学意义(均P<0.05).良性增生组织中的Galectin-3表达阳性率为0.00%(0/28),低于良性腺瘤组织的15.38%(2/13),且差异有统计学意义(均P<0.05).乳头状癌、髓样癌、滤泡状癌中的Galectin-3与CD44v6表达阳性率均高于低分化或未分化癌,且差异有统计学意义(均P<0.05).恶性甲状腺结节患者的家族史、辐射暴露以及碘摄入过量人数占比均高于对照组,且差异有统计学意义(均P<0.05).经多因素Logistic回归分析发现,甲状腺家族史、辐射暴露以及碘摄入过量均是甲状腺癌危险因素.结论 Galectin-3与CD44v6检测应用于甲状腺癌鉴别诊断的价值较高,有利于区别良性甲状腺结节中的良性增生以及良性腺瘤,同时可有效区别恶性甲状腺结节中的乳头状癌、髓样癌、滤泡状癌以及低分化或未分化癌.     

甲状腺滤泡癌的分子生物学研究进展

甲状腺癌是常见的一类发生在内分泌腺的恶性肿瘤,其常见类型为甲状腺乳头状癌(papillary thyroid carcinoma),甲状腺滤泡癌(follicular thyroid carcinoma)次之。典型的甲状腺滤泡癌易于诊断。多年来研究表明甲状腺滤泡癌与乳头状癌,在病因、形成机制、生物学行为及预后上都有很大差别。另外,甲状腺滤泡癌在冷冻切片、细针穿刺诊断中,常常     

甲状腺癌超声诊断与病理诊断对比分析和研究

目的 比较超声诊断与病理诊断甲状腺癌的符合率,探讨甲状腺癌超声诊断的特点以及临床诊断价值.方法 对159例甲状腺疾病患者超声诊断后,诊断结果与术后病理学检查和穿刺细胞学诊断确诊结果比较分析.结果 159例患者超声诊断甲状腺癌47例(与病理诊断结果相比符合率68.1％)、甲状腺良性肿瘤40例(83.3％)、甲状腺炎42例(100％),与病理诊断结果相比,差异无统计学意义(P＞0.05).30例诊断不符合,其中22例甲状腺癌被误诊为良性肿瘤,6例良性肿瘤被误诊为甲状腺炎,2例良性肿瘤被误诊为甲状腺癌.甲状腺癌确诊病例中,超声确诊乳头状癌40例(81.6％),滤泡状癌5例(41.7％),髓样癌2例(25.0％),差异有统计学意义(P＜0.05);不同甲状腺癌超声影像表现中,乳头状癌与滤泡状癌和髓样癌超声影像相比,差异有统计学意义(P＜0.05),滤泡状癌和髓样癌超声影像比较,差异无统计学意义(P＞0.05).结论 超声检查诊断甲状腺癌具有优缺点,合理运用可提高诊断准确率     

超声引导下甲状腺细针穿刺在鉴别良恶性结节中的临床价值

目的分析超声引导行细针穿刺细胞学检查(US-FNAC)诊断甲状腺良恶性结节有效性。方法将58例可疑甲状腺恶性结节的患者均行US-FNAC检查,以手术切除病变组织的病理学检查结果为金标准,观察US-FNAC对甲状腺良恶性结节检出情况,US-FNAC用于结节良恶性诊断的临床价值(敏感性、特异性)。结果病理学检查结果显示69枚结节,57枚为恶性结节,占82. 6%,良性结节12枚,占17. 4%;而US-FNAC用于检测特异性为83. 3%,敏感性为89. 5%,准确率为88. 4%。结论 US-FNAC用于甲状腺结节性质诊断临床价值较高,能有效诊断良、恶性结节,且不易造成患者声音嘶哑、穿刺点出血等并发症。     

CT引导下经皮肺穿刺细胞学和组织学联合检查的诊断价值

目的探讨CT引导下经皮肺穿刺细胞学和组织病理学联合检查在肺部周围性和弥漫性病变诊断中的价值。方法回顾性分析370例CT引导下经皮肺穿刺标本,分析细胞学与组织病理学诊断方法的相关性,比较细胞学、组织病理学以及两者结合诊断的敏感性、假阴性率,分析细胞学分型的准确率。结果 370例肺穿刺标本中,组织病理学诊断为癌、恶性肿瘤、疑癌、异型和阴性的例数分别为177(47.84%)、22(5.95%)、16(4.32%)、12(3.24%)和143(38.65%),细胞学诊断相应的例数为166(44.87%)、10(2.70%)、16(4.32%)、49(13.24%)和129(34.87%),两种检测方法结果相关(P0.001)。细胞学诊断敏感性为80.00%(192/240),组织病理学诊断敏感性为89.58%(215/240),两者结合诊断敏感性为98.33%(236/240),细胞学诊断与组织病理学诊断的敏感性差异有显著性(P0.05),组织病理学与两者结合诊断敏感性差异有显著性(P0.05)。细胞学阳性病例分型准确率为66.15%(127/192)。术中及术后并发症为14.59%,其中气胸31例,针道出血或痰中带血23例,均经相应处理后好转。结论 CT引导下经皮肺穿刺对于肺部病变是安全的、高敏感性和高准确性的定性诊断方法,同时行细胞学和组织病理学检查可显著提高诊断率,临床应用价值高。     

GADD153在甲状腺滤泡样肿瘤中的表达及与CK19、Galectin-3和HBME-1的对比研究

目的 探讨GADD153在甲状腺滤泡样肿瘤中的表达及其鉴别诊断价值,并与CK19、Galectin-3(简称Gal-3)和HBME-1进行对比.方法 应用免疫组织化学EnVision法检测了34例甲状腺滤泡性腺瘤、46例甲状腺滤泡性癌及29例甲状腺滤泡型乳头状癌中GADD153、CK19、Gal-3和HBME-1的表达情况.结果 (1)GADD153的表达位于细胞核,在甲状腺滤泡性癌中的表达大多为中度阳性或强阳性,在滤泡性腺瘤和滤泡型乳头状癌中的表达多为阴性或弱阳性,阳性表达率分别为82.6％( 38/46)、32.4％( 11/34)、10.3％ (3/29),滤泡性癌明显高于滤泡性腺瘤和滤泡型乳头状癌,差异均有统计学意义(x2值分别为20.80和37.48;均P＜0.01).(2)CK19、Gal-3和HBME-1 三种标志物均表达于细胞质,其阳性表达率在滤泡性癌为54.3％( 25/46)、67.4％ (31/46)、58.7％( 27/46),在滤泡性腺瘤为50.0％( 17/34)、29.4％( 10/34)、32.4％( 11/34),在滤泡型乳头状癌为100％( 29/29)、93.1％ (27/29)、89.7％ (26/29),滤泡型乳头状癌与滤泡性腺瘤、滤泡性癌间比较,差异亦均有统计学意义(x2值分别为21.20和8.22;均P＜0.01).(3)根据CK19、Gal-3、HBME-1和GADD153四种标志物表达的强弱分为低表达组(记为0和1+)和高表达组(记为2+和3+),分别计算其在各组的敏感性和特异性.滤泡性腺瘤组敏感性分别为26.5％、8.8％、2.9％和11.8％,特异性为50.7％、52.0％、54.7％和58.7％;滤泡性癌组敏感性分别为19.6％、26.1％、23.9％和65.2％,特异性为41.3％、57.1％、62.0％和92.1％;滤泡型乳头状癌组敏感性分别为96.6％、82.8％、79.3％和3.4％,特异性为77.5％、81.3％、85.0％和57.5％.结论 GADD153对甲状腺滤泡性癌诊断的敏感性和特异性均较好,而CK19、Gal-3和HBME-1则能更好地提示甲状腺滤泡型乳头状癌.四者联合应用能更好地鉴别甲状腺滤泡性肿瘤.     

Primary lymphangioma of the thyroid gland

A 21-year-old woman presented with a solitary, hypofunctioning right thyroid nodule. Findings of fine-needle aspiration biopsy were consistent with a thyroid cyst, but a subsequent biopsy demonstrated changes suggestive of a papillary neoplasm. Surgery was performed and a well-circumscribed 12-mm nodule was identified within the thyroid parenchyma. Microscopic examination confirmed the presence of a thyroid lymphangioma. To our knowledge, this is the first case of a primary thyroid lymphangioma reported in the English literature.     

Coccidioides thyroiditis in an HIV-infected patient

We report a case of Coccidioides thyroiditis in an HIV-infected patient with a history of recent Coccidioides pneumonia but with negative Coccidioides serology determined by enzyme immunoassay at presentation. Diagnosis of Coccidioides thyroiditis was made based on histopathologic examination and culture of thyroid abscess material obtained by fine-needle aspiration biopsy.     

Fine-needle aspiration biopsy of primary osteosarcoma of the thyroid: report of a case and review of the literature

Primary osteosarcoma of the thyroid is an extremely rare tumor, with only 27 well-documented cases reported in the literature, including only one in the cytology literature. We describe here an additional case with fine-needle aspiration biopsy findings. A 60-year-old woman presented with a 1-month history of progressive midline neck swelling. CT and ultrasound demonstrated a large thyroid mass with tracheal compression. Fine-needle aspiration biopsies were performed and showed pleomorphic spindle and epithelioid neoplastic cells, multinucleated giant cells, and scant metachromatic extracellular matrix material. Cell block sections contained minute tissue fragments with neoplastic spindle cells. Immunohistochemical stains showed the tumor cells to be positive for vimentin and negative for cytokeratins, TTF-1, calcitonin, synatophysin, chromogranin, and S-100 protein, suggesting a sarcoma; however, the differential diagnosis also included anaplastic thyroid carcinoma and medullary thyroid carcinoma. Tissue biopsy revealed a high-grade spindle cell neoplasm with osteoid production, consistent with osteosarcoma of the thyroid. The patient developed a large pulmonary embolus and superior vena cava syndrome and no further surgical intervention was performed. She died 5 weeks after the initial diagnosis. Upon retrospective review, the cytologic features resemble osteosarcoma in other areas. Although cytologic features on fine-needle aspiration biopsy may suggest a diagnosis of this rare entity, definitive diagnosis should be deferred to histologic examination.     

Diagnostic value of liquid-based (Liqui-PREP) preparations and interobserver reproducibility in fine needle aspiration cytology of the nodular thyroid lesions

The aim of this study is to define the diagnostic role of Liqui-Prep (LP) technique for the diagnosis of thyroid lesions and to assess interobserver variabilities. In all, 98 thyroid FNA (fine needle aspiration) cytology samples from 83 patients for preoperative evaluation of thyroid nodules, prepared by the LP, were examined. The LP slides were independently evaluated by three pathologists and they were classified into the five categories according to the Bethesda system. The histopathologic diagnoses were grouped as follows: benign, follicular neoplasm, and malignant. Agreements between LP and histopathologic diagnoses were investigated using kappa values. Marginal homogenity and kappa tests were used for statistical analysis for the evaluation of the agreement between the pathologists and the interobserver variability of the thyroid aspiration cytology results. The presence of nucleoli, nuclear grooving, overlapping, intranuclear inclusion, and nuclear irregularity were recorded and scored on each case based on LP slide review. Concurrences between LP and the histologic diagnoses for the three pathologists were almost perfect (k = 0.798; k = 0.826; k = 0.880). When the observers were paired there was no significant difference from the diagnostic point of view. Interobserver agreement among the three pathologists was moderate. Initially diagnostic difficulties may occur because of the inadequate experience of the pathologists concerning the evaluation of the cytologic changes associated with this new technique. Liqui-Prep technique is useful for the cytologic diagnosis of the thyroid nodules. The nuclear irregularity was the most essential feature for the differentiation of malignant lesions from follicular neoplasm by the LP method.     

Accuracy of fine-needle aspiration of thyroid

CONTEXT: Fine-needle aspiration has become an accepted and cost-effective procedure for rapid diagnosis of thyroid lesions. The routine use of fine-needle aspiration has reduced the rate of unnecessary surgery for thyroid nodules. OBJECTIVES: To determine the accuracy of fine-needle aspiration biopsy diagnosis and to discuss the possible pitfalls. Design, Setting, and Participants.-Reports of 6226 fine-needle aspiration biopsies of the thyroid performed during a period of 16 years (1982-1998) were reviewed. Computerized reports of the fine-needle aspiration biopsies were sent to the physicians who performed the procedures, and clinical follow-up information regarding the patients was requested. Twenty-four clinicians participated in the study. Histologic diagnoses were available for 354 cases. The cytopathologic diagnoses were correlated with the histologic findings or clinical outcomes. RESULTS: The cytologic diagnoses were as follows: 210 (3.4%) malignant, 450 (7.2%) suspicious, 3731 (60%) benign, and 1845 (29.5%) unsatisfactory. Most of the cases with negative or unsatisfactory aspirates were followed clinically or by repeat fine-needle aspiration. We identified 11 false-negative and 7 false-positive diagnoses. For aspirates considered sufficient for diagnosis, the sensitivity and specificity levels were 93% and 96%, respectively. CONCLUSIONS: Fine-needle aspiration of the thyroid gland is highly accurate and has a low rate of false-negative and false-positive diagnoses. The major diagnostic problems are caused by diagnosis using a marginally adequate specimen, diagnosis of malignancy based on just 1 or 2 atypical cytologic features, or overlapping cytologic features of follicular neoplasm with those of follicular variant of papillary carcinoma.     

Analysis of the bethesda system for reporting thyroid cytopathology and similar precursor thyroid cytopathology reporting schemes

The Bethesda System for Reporting Thyroid Cytopathology is a standardized reporting system for classifying thyroid fine-needle aspiration results comprising of 6 diagnostic categories with unique risks of malignancy and recommendations for clinical management. The majority of thyroid nodules are benign; however, up to 30% of fine-needle aspiration of thyroid nodule results are equivocal. Until 2007, various diagnostic terms were used to classify such cases, including "atypical," "indeterminate," and rule-out or cannot exclude malignancy. A literature review of 13 original studies was conducted to evaluate whether utilization of the Bethesda System for Reporting Thyroid Cytopathology nomenclature represent an improvement over thyroid cytopathology reporting schemes used before 2007 in diagnosing thyroid malignancy. The sensitivity and specificity of thyroid fine-needle aspiration was high in the studies that assessed the measures. However, a selection bias exists and most studies do not include indeterminate diagnosis in their calculations. Although the Bethesda System for Reporting Thyroid Cytopathology recommends a repeat fine-needle aspiration to follow-up nondiagnostic specimens, in the majority of studies, an appreciable number of cases underwent follow-up surgical biopsy or thyroidectomy. The diagnostic category of atypia/follicular lesion of undetermined significance remains heterogenous in terms of usage and clinical outcome. The majority of the studies that utilize the Bethesda System for Reporting Thyroid Cytopathology in this literature review retrospectively reclassified thyroid fine-needle aspiration into the Bethesda System for Reporting Thyroid Cytopathology nomenclature with reported malignancy rates that are similar between cases reclassified as atypia/follicular lesion of undetermined significance and follicular neoplasm/suspicious for follicular neoplasm.     

Diagnostic problems in tissues previously sampled by fine-needle aspiration.

Unusual tissue changes in needle tracts after fine-needle aspiration were studied in two specimens. One specimen, a 3.0 x 2.5 cm mesenteric nodule, was found six days after a nondiagnostic transabdominal fine-needle aspiration of a retroperitoneal mass. At frozen-section examination, the nodule had proliferating spindle-shaped cells interspersed with adipocytes that raised the possibility of well-differentiated liposarcoma. On permanent sections, however, there was fat necrosis and reactive spindle-shaped cells that immunohistochemically were consistent with myofibroblasts. In the second case, a needle tract was noted in breast tissue on which a biopsy was performed two days after a cytologic diagnosis of carcinoma. The 0.4-mm-wide tract contained neutrophils, foamy histiocytes, and clumps of intact, atypical epithelial cells without a desmoplastic or elastotic component. Aside from these epithelial cells, nothing in the biopsy specimen suggested invasive carcinoma. The cells were identical to those from a comedocarcinoma present in the biopsy and mastectomy specimens. These two cases provide examples of pitfalls that may arise during the examination of biopsy specimens obtained after fine-needle aspiration.     

Comparison of Consecutive Results from Fine Needle Aspiration and Core Needle Biopsy in Thyroid Nodules

There are papers suggesting the complementary role of core needle biopsy (CNB) in the diagnosis of thyroid nodules. By comparing the result of CNB and fine needle aspiration (FNA) cytology performed in consecutive cases of thyroid nodules, the role of CNB was evaluated. Retrospective reviews of 2131 FNA and 275 CNB which were performed as first-line biopsy for 2406 thyroid nodules in 2187 patients were performed. The ultrasound (US) feature of thyroid nodule was classified following the risk of malignancy suggested by American Thyroid Association (ATA) guideline. Rate of unsatisfactory and cellular atypia could be decreased significantly by first-line CNB in all US group, and the nodules with highly suspicious feature showed significant decrease in inconclusive result by first-line CNB. However, increased rates of architectural and follicular neoplasm (FN) were identified in CNB group especially in intermediate and low suspicious nodules, and the first-line CNB could not decrease the inconclusive result in these US groups. The diagnostic rate of neoplasm diagnosed by surgery following the result of architectural atypia or FN was not different between FNA and CNB even with significantly higher rate in CNB group. Furthermore, the sensitivity for follicular neoplasm (21.2 vs. 61.9%) was significantly higher in CNB group. The CNB can be considered in nodules with highly suspicious feature with advantage of significantly lower inconclusive diagnostic rate than FNA group. However, significantly increased diagnosis of architectural atypia or FN in other nodules by CNB is recognized and should be evaluated in future to understand the meaning.     

Non-Hodgkin's lymphoma of the breast: a review of 18 primary and secondary cases

We evaluated the clinical features, morphology, and incidence of 18 cases of breast lymphoma over 10 years at the University of Alabama at Birmingham. Fine needle aspiration was performed in 7 of 18 patients, and tissue biopsy/resection was available for all 18 cases. Patients were 33 to 91 years old (median, 61); 17 were women and 1 was a man. Fine needle aspiration was consistent with the tissue diagnosis in 6 of the 7 cases (86%). One case was diagnosed by fine needle aspiration as atypical cells, favor benign; the biopsy revealed diffuse large B-cell lymphoma. Tissue diagnoses revealed that 11 cases (61%) represented diffuse large B-cell lymphoma and 3 (17%) were follicular lymphomas. The remaining 4 cases (22%) were plasma cell neoplasm, T-cell neoplasm, Burkitt's lymphoma, and precursor B-cell lymphoblastic lymphoma. Flow cytometry and/or gene rearrangement supported the diagnosis of lymphoma in 8 cases. Although rare, lymphoma should be considered in the differential diagnosis of a breast mass. Fine needle aspiration can facilitate appropriate triage of patients for further management.     

Ectopic cervical thymic tissue: diagnosis by fine needle aspiration

Cervical thymic masses are congenital lesions that result from aberrant thymic migration during embryogenesis. Although most of these masses are asymptomatic, they may cause debilitating symptoms secondary to encroachment on adjacent aerodigestive structures. Preoperative diagnosis of ectopic thymic tissue is rare; most cases are clinically misinterpreted as branchial cleft remnants or cystic hygromas. Definitive diagnosis has relied on histopathologic examination in nearly all reported cases. However, the invasiveness of open incisional or excisional biopsy carries the risk of surgical and anesthetic complications. Inadvertent surgical thymectomy may result in cell-mediated immune deficiencies in infants and young children. The utility of fine needle aspiration is gaining wider acceptance in the diagnostic evaluation of neck masses. We describe an infant with an asymptomatic cervical thymic mass diagnosed by fine needle aspiration.