老年甲状腺结节382例细针穿刺活检临床病理分析

Fine-needle aspiration biopsy for thyroid nodules：a clinical and pathological study of 382 elderly patients

目的：分析老年甲状腺结节细针穿刺活检（FNAB）临床病理特点。方法回顾性分析2005年5月至2011年10月于中日友好医院行FNAB的382例老年患者的临床病理资料。细胞病理诊断按美国甲状腺细胞病理学贝塞斯达报告系统6（BSTC6）分类标准进行归类统计。临床资料包括患者年龄、性别、甲状腺功能检查以及甲状腺超声检查结果等。结果382例行FNAB的患者中无法诊断占14.7%（56/382），良性病变占71.7%（274/382），意义不明确的非典型病变/滤泡性病变占3.4%（13/382），滤泡性肿瘤占4.7%（18/382），可疑恶性肿瘤占2.1%（8/382），恶性肿瘤占3.4%（13/382）。382例FNAB患者中有355例检查甲状腺功能，甲状腺功能正常占70.1%（249/355），甲状腺功能异常占29.9%（106/355）。结论老年甲状腺结节患者以良性病变为主，术前行FNAB可避免良性结节的手术治疗。老年甲状腺结节患者甲状腺功能异常比例高，对老年甲状腺结节患者检测甲状腺功能非常重要。

Objective To analyze the clinical and pathological features of thyroid nodule fine-needle aspiration biopsy （FNAB） in the elderly. Methods Clinical and pathological data of 382 elderly patients receiving thyroid nodule FNAB in our hospital during May 2005 to December 2011 were collected and retrospectively analyzed. Cytopathological diagnosis of FNAB was classified as nondiagnostic/unsatisfactory, benign, atypia of undetermined significance/follicular lesion （AUS/FL）, follicular neoplasm （FN）, suspicious malignancy and malignancy according to the Bethesda System for Reporting Thyroid Cytopathology 6 （BSTC6）. Clinical data included age, sex, thyroid function test and thyroid ultrasound findings. Results Of 382 thyroid nodule FNAB, 14.7% （56/382）, 71.7% （274/382）, 3.4% （13/382）, 4.7% （18/382）, 2.1%（8/382） and 3.4%（13/382） were classified as nondiagnostic, benign, AUS/FL, FN, suspicious malignancy, and malignant, respectively. Among the 355 patients receiving thyroid function test, 70.1% （249/355） were identified as euthyroid and 29.9% （106/355） had thyroid dysfunction. Conclusion Most elderly patients have benign lesions of thyroid nodule, and preoperative FNAB can avoid the surgical treatment for thyroid nodules. Elderly patients with thyroid nodules have a high risk of thyroid dysfunction, and it is very important for them to take thyroid function test.