甲状腺多发结节细针穿刺细胞学检查的困境及对应策略

FNAC dilemmas and strategies in multiple thyroid nodules

摘要:

细针穿刺细胞学检查（FNAC）是鉴别甲状腺结节良恶性非常有效的手段，国内外指南对多发结节的FNAC指征只达成了少数共识，而实际工作中如何对多发结节进行FNAC决策，尚存在许多困惑：包括如何从甲状腺多发结节中筛选出具有FNAC指征的结节？多个结节具有FNAC指征，如何选择？多个结节FNAC后，是否均需要基因检测？FNAC与超声风险结果不一致时，如何进行下一步方案选择？当FNAC诊断滤泡性肿瘤或可疑滤泡性肿瘤时，如何进行决策？该文结合文献与国内实际情况，对甲状腺多发结节FNAC指征的把握及相应策略进行探讨。

Abstract:

Fine-needle aspiration cytology (FNAC) biopsy is a very effective method for differentiating benign and malignant thyroid nodules, but only a few consensuses have been reached on the indications for FNAC of multiple thyroid nodules according to various guidelines. Thus, there are still a lot of unresolved issues associated with FNAC of multiple thyroid nodules in clinical practice including: how to determine the nodules with indications for FNAC from multiple thyroid nodules; which to choose when multiple nodules are indicative of a need for FNAC; whether all samples require further gene detection if multiple modules are evaluated with FNAC; what to do next when the results of FNAC and ultrasound are inconsistent; and how to make clinical decisions when the results of FNAC indicate follicular neoplasm. This article discusses corresponding strategies for these five common clinical dilemmas based on the literatures and specific conditions in our country.