Purpose

Follicular variant papillary thyroid carcinoma (FVPTC) is a problematic entity. FVPTCs are often misdiagnosed by the standard fine needle aspiration (FNA); in addition, FVPTCs represent a mixed group of tumors with two biologically distinct subtypes: The indolent encapsulated FVPTC and the aggressive infiltrative FVPTC. Recent changes in guidelines suggests that FVPTC management may be improved if subtypes can be determined preoperatively. Preoperative assays, FNA, core needle biopsy (CNB), and ultrasonography (US) were compared for their ability to identify and subtype FVPTCs to determine the most appropriate test to manage FVPTCs.

Methods

The preoperative assays and clinicopathologic variables of 255 resected FVPTCs cases at Samsung Medical Center between 2012 and 2016 were retrospectively evaluated.

Results

CNB had the overall best ability to manage FVPTCs with the highest rate of diagnosis indicating surgery, lowest rate of inconclusive results, high sensitivity (88.9%), specificity (87.7%), negative predictive value (97.0%), diagnostic odds ratio (DOR; 56.9), and excellent predictive ability (AUC 0.906) for differentiating FVPTC subtypes. US had a moderate DOR (12.8), good predictive ability (AUC 0.802), high sensitivity (75.0%) and specificity (81.0%). CNB and US both had significantly higher accuracy for discriminating FVPTC subtypes than FNA (AUC 0.908 and 0.877 > 0.671; p < 0.05). The excellent performance of CNB could be attributed to distinct histologic differences between FVPTC subtypes.

Conclusion

CNB and US had superior performance to FNA in the identification and subtyping of FVPTC. In institutions with skilled and experienced operators, CNB is the preferred method for evaluating possible FVPTC lesions.

中文翻译：

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在滤泡型甲状腺乳头状癌的治疗中，芯针活检和超声检查优于细针抽吸

目的

滤泡性甲状腺乳头状癌（FVPTC）是一个有问题的实体。FVPTC 经常被标准细针穿刺 (FNA) 误诊；此外，FVPTC 代表了具有两种生物学不同亚型的混合肿瘤组：惰性包膜 FVPTC 和侵袭性浸润性 FVPTC。最近指南的变化表明，如果可以在术前确定亚型，则 FVPTC 管理可能会得到改善。比较了术前检测、FNA、核心针活检 (CNB) 和超声检查 (US) 对 FVPTC 的识别能力和亚型以确定管理 FVPTC 的最合适的测试。

方法

回顾性评估了三星医疗中心 2012 年至 2016 年间 255 例切除的 FVPTC 病例的术前检测和临床病理变量。

结果

CNB 具有管理 FVPTCs 的总体最佳能力，具有最高的手术诊断率、最低的不确定结果率、高敏感性 (88.9%)、特异性 (87.7%)、阴性预测值 (97.0%)、诊断优势比 (DOR) ; 56.9)，以及区分 FVPTC 亚型的出色预测能力 (AUC 0.906)。US 具有中等 DOR (12.8)、良好的预测能力 (AUC 0.802)、高敏感性 (75.0%) 和特异性 (81.0%)。CNB 和 US 在区分 FVPTC 亚型方面的准确度均显着高于 FNA（AUC 0.908 和 0.877 > 0.671；p  < 0.05）。CNB 的优异表现可归因于 FVPTC 亚型之间明显的组织学差异。

结论

CNB和US在FVPTC的识别和分型方面优于FNA。在拥有熟练和经验丰富的操作人员的机构中，CNB 是评估可能的 FVPTC 病变的首选方法。