Thyroid cytological examination, a key tool in preoperative thyroid nodule evaluation, is specific and accurate; some drawbacks are due to inadequate or indeterminate cytological reports and there is a need for an innovative approach overcoming the limits of traditional cytological diagnostics. Fluorescence laser confocal microscopes (FCM) is a new optical technique for allowing immediate digital imaging of fresh unfixed tissues and real-time assessment of sample adequacy and diagnostic evaluation for small biopsies and cytological samples. Currently, there are no data about the use of FCMs in the field of thyroid nodular pathology. The aims of this study were to test FCM technology for evaluating the adequacy of FNA samples at the time of the procedure and to assess the level of concordance between FCM cytological evaluations, paired conventional cytology, and final surgical histology. The secondary aim was to define the integrity of nucleic acids after FCM evaluation through NGS molecular analysis. Sample adequacy was correctly stated. Comparing FCM evaluation with the final histology, all cases resulting in malignant or suspicious for malignancy at FCM, were confirmed to be carcinomas (PPV 100%). In conclusion, we describe a successful application of FCM in thyroid preoperative cytological evaluation, with advantages in immediate adequacy assessment and diagnostic information, while preserving cellular specimens for permanent morphology and molecular analysis, thus improving timely and accurate patient management.
甲状腺细胞学检查作为术前甲状腺结节评估的关键工具，具有特异性强、准确性高的特点；其局限性主要源于细胞学报告不充分或结果不确定，因此需要创新方法以突破传统细胞学诊断的局限。荧光激光共聚焦显微镜是一种新型光学技术，能够对新鲜未固定组织进行即时数字成像，并对小活检样本及细胞学标本的取材充分性实现实时评估与诊断判断。目前尚无该技术在甲状腺结节病理学领域应用的相关数据。本研究旨在验证荧光激光共聚焦显微镜技术在细针穿刺取样过程中评估样本充分性的可行性，并评估其细胞学诊断结果与配对常规细胞学检查、最终手术组织病理学诊断的一致性。次要目标是通过二代测序分子分析确定荧光激光共聚焦显微镜检测后核酸的完整性。研究证实该技术能准确判定样本充分性。将荧光激光共聚焦显微镜评估结果与最终组织病理学对照发现，所有经荧光激光共聚焦显微镜判定为恶性或可疑恶性的病例均被证实为癌变（阳性预测值100%）。综上所述，本研究成功将荧光激光共聚焦显微镜应用于甲状腺术前细胞学评估，该技术在即时充分性评估和诊断信息获取方面具有优势，同时能完整保存细胞样本用于永久形态学分析和分子检测，从而提升临床诊疗的时效性与精准性。
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