超声检查和分子检测对意义不明确甲状腺结节诊断的研究进展

Research advances in preoperative diagnosis of atypia of undetermined significance/follicular lesion of undetermined significance

甲状腺结节在人群中检出率较高,术前确定结节良恶性尤为重要。超声引导下细针穿刺细胞学检查(ultrasonographyguided fine needle aspiration cytology,US-FNAC)可鉴别大多数甲状腺结节的良恶性,但细胞学结果判读的影响因素繁多,在甲状腺细胞病理学Bethesda报告系统中有15%~30%结节被诊断为意义不明确的细胞非典型病变/滤泡性病变(atypia of undetermined significance/follicular lesion of undetermined significance,AUS/FLUS)。AUS/FLUS结节一直是令病理和临床医生感到棘手的问题,其细胞组织结构异型性较小,不能诊断为可疑滤泡性肿瘤、可疑恶性肿瘤或恶性肿瘤。随着各种检测方法的进步,人们对AUS/FLUS结节的认识逐渐清晰。本文就超声检查和分子检测在AUS/FLUS术前诊断中的临床应用和价值作一综述。

Thyroid nodules are prevalent in the population,but most of them are benign.Therefore,it is of great significance to decide which nodules require evaluation and intervention.Ultrasonography-guided fine needle aspiration cytology(FNAC)is a simple and accurate method for estimating the risk of malignancy and assisting rational triage of patients to surgery or observation.Up to 30%of thyroid nodules are diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance(AUS/FLUS).AUS/FLUS nodules have always been a thorny problem for pathologists and clinicians.There are not enough cytologic findings to call it“benign follicular nodule”or“follicular neoplasm”or“malignant”,then the phrase of AUS/FLUS is used.With the development of various detection methods,the recognition of AUS/FLUS nodules has become increasingly clear.In this paper,we review the clinical application and value of ultrasonography and molecular detection in preoperative diagnosis of AUS/FLUS.