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Preoperative Diagnosis of Benign Thyroid Nodules with Indeterminate Cytology
Ist Teil von
The New England journal of medicine, 2012-08, Vol.367 (8), p.705-715
Ort / Verlag
Waltham, MA: Massachusetts Medical Society
Erscheinungsjahr
2012
Quelle
Free E-Journal (出版社公開部分のみ)
Beschreibungen/Notizen
A significant fraction of fine-needle aspirates obtained from thyroid nodules are read as indeterminate. A new molecular test accurately predicts whether a cytologically indeterminate nodule is benign 93% of the time, permitting a conservative approach to management.
Thyroid nodules are common and are usually benign.
1
However, 5 to 15% prove to be malignant; accordingly, identification of a nodule 1 cm or larger in diameter often prompts a diagnostic evaluation.
2
,
3
The cornerstone of thyroid-nodule evaluation is fine-needle aspiration,
4
which enables the assessment of cellular morphologic features that could not be identified by means of clinical assessment or imaging. Preoperative, ultrasonographically guided fine-needle aspiration has been shown to accurately classify 62 to 85% of thyroid nodules as benign, thereby avoiding diagnostic surgery.
5
However, 15 to 30% of aspirations yield indeterminate cytologic findings,
4
which include three subtypes: “atypia (or . . .