文章：

弥漫性C细胞增生是甲状腺结节细针穿刺冲洗液中降钙素测量假阳性的来源：避免不必要手术的合理临床策略

Diffuse C-Cells Hyperplasia Is the Source of False Positive Calcitonin Measurement in FNA Washout Fluids of Thyroid Nodules: A Rational Clinical Approach to Avoiding Unnecessary Surgery

原文发布日期：2 January 2024

DOI: 10.3390/cancers16010210

类型: Article

开放获取: 是

英文摘要：

Purpose: The FNA-CT is useful for the diagnosis of MTC. The aim of this study was to evaluate the performance of FNA-CT in TNs coexisting with CCH. Methods: This study retrospectively reviewed the records of 11 patients with TNs submitted to thyroidectomy on the basis of elevated basal and/or stimulated serum CT values, which at histology were not confirmed to be MTC. The results obtained in this group were compared with those of a previously reported group of histologically proven MTC patients submitted to an identical presurgical evaluation. All patients, negative for known mutations in the RET proto-oncogene, were preoperatively submitted to neck ultrasound, FNA-cytology, and FNA-CT. Results: Approximately 6 of 11 patients showed increased (>36 ng/mL, as established in previous studies not involving patients with CCH) FNA-CT. All these patients showed diffuse CCH at histology in the thyroid lobe submitted to FNA; 5 of them were benign at histology, while only one was malignant (papillary thyroid carcinoma, PTC). The remaining 5 of 11 patients had low FNA-CT (<36 ng/mL), and all of them showed only focal CCH in the lobe submitted to FNA; three of them were malignant (2 PTC, 1 follicular carcinoma), while two were benign. Conclusions: Employing the currently proposed cut-off values, false-positive FNA-CT results may be observed in benign/malignant TNs with coexisting diffuse CCH. FNA-CT must therefore be cautiously used in the diagnostic approach for patients with TNs and a slightly increased basal or stimulated serum CT concentration in order to avoid unnecessary surgery.

摘要翻译： 

目的：细针穿刺降钙素检测（FNA-CT）对甲状腺髓样癌（MTC）的诊断具有价值。本研究旨在评估FNA-CT在合并C细胞增生（CCH）的甲状腺结节（TNs）中的诊断效能。方法：本研究回顾性分析了11例因基础及/或激发后血清降钙素水平升高而接受甲状腺切除术的甲状腺结节患者的资料，这些患者术后病理均未证实为MTC。将本组患者的结果与既往报道的一组经组织学证实为MTC、且接受相同术前评估的患者结果进行比较。所有患者均未检出已知的RET原癌基因突变，术前均接受了颈部超声、细针穿刺细胞学检查及FNA-CT。结果：11例患者中，约6例患者的FNA-CT水平升高（>36 ng/mL，此阈值基于既往未纳入CCH患者的研究确定）。这些患者在接受FNA的甲状腺叶中，组织学均显示为弥漫性CCH；其中5例病理结果为良性，仅1例为恶性（甲状腺乳头状癌，PTC）。其余5例患者FNA-CT水平较低（<36 ng/mL），在接受FNA的甲状腺叶中均仅显示局灶性CCH；其中3例为恶性（2例PTC，1例滤泡状癌），2例为良性。结论：采用目前提出的临界值，在合并弥漫性CCH的良性/恶性甲状腺结节中，可能会观察到FNA-CT假阳性结果。因此，对于甲状腺结节患者，若其基础或激发后血清降钙素浓度轻度升高，在诊断过程中应谨慎使用FNA-CT，以避免不必要的手术。

原文链接：

Diffuse C-Cells Hyperplasia Is the Source of False Positive Calcitonin Measurement in FNA Washout Fluids of Thyroid Nodules: A Rational Clinical Approach to Avoiding Unnecessary Surgery