Language:
Japanese
In:
日本臨床細胞学会雑誌, 2018, Vol.57(3), pp.151-158
Description:
〈p〉〈b〉目的〈/b〉 : 甲状腺髄様癌の細胞診所見について検者間誤差の生じにくい細胞所見と核の計測値を用いて診断に有用な所見を検索し, 診断率向上と診断のアルゴリズムの提案を検討する.〈/p〉〈p〉〈b〉方法〈/b〉 : 髄様癌 78 例, 乳頭癌 20 例, 低分化癌 20 例, 濾胞癌 20 例の細胞診標本を対象に, 細胞形態学的鑑別, 細胞計測, 統計学的解析を行い, 髄様癌の鑑別に有用な項目を求めた.〈/p〉〈p〉〈b〉成績〈/b〉 : 髄様癌の診断に有用な所見は, 1) 粗顆粒状のクロマチン, 2) 4 核以上の多核腫瘍細胞, 3) アミロイド, 4) 核の縦横比 1.6 以上, 5) 核の縦横比 CV 25%以上, 6) 核の長径の最小値と最大値の比 3.7 以上であった. これらの所見は髄様癌 59 例に認められ, 乳頭癌, 濾胞癌, 低分化癌には認められなかった. さらに, ロジスティック回帰分析により髄様癌 7 例を推定した.〈/p〉〈p〉〈b〉結論〈/b〉 : 検者間誤差が生じにくい細胞所見および計測値を用いたアルゴリズムを用いることにより, 髄様癌の 84.6%が診断可能であった.〈/p〉
Description:
〈p〉〈i〉〈b〉Objective〈/b〉〈/i〉 : We examined the cytological features of medullary carcinoma (MC) of the thyroid gland, including the nuclear dimensions, in order to identify useful diagnostic features for MC that are unlikely to be beset by errors arising from inter-examiner differences, and propose a diagnostic algorithm for improvement of the diagnosis rate.〈/p〉〈p〉〈i〉〈b〉Study Design〈/b〉〈/i〉 : Using cytological specimens obtained from 78 cases of MC, 20 cases of papillary carcinoma, 20 cases of follicular carcinoma and 20 cases of poorly differentiated carcinoma of the thyroid gland, we compared the rates of detection of salt and pepper chromatin, nuclear grooves, nuclear cytoplasmic inclusion bodies and multinucleated carcinoma cells, the amyloid and nuclear areas, the nuclear aspect ratio (ratio of the major axis diameter to minor axis diameter?), and the long diameter of the nuclei in order to identify features useful for the diagnosis of MC.〈/p〉〈p〉〈i〉〈b〉Results〈/b〉〈/i〉 : Diagnosis of MC was confirmed in 59 cases. It was estimated by logistic regression analysis in a further 7 cases. Based on our findings, we suggest the following as useful features for the diagnosis of MC : 1) salt and pepper appearance of the nuclear chromatin ; 2) 4 or more multinucleated carcinoma cells ; 3) presence of amyloid ; 4) nuclear aspect ratio≥1.6 ; 5) CV of the nuclear aspect ratio≥25%, 6) ratio between the minimum and maximum longest diameters of the nuclei≥3.7.〈/p〉〈p〉〈i〉〈b〉Conclusion〈/b〉〈/i〉 : Among the 78 specimens of MC, the diagnosis could be made by cytologic examination in 66 cases (84.6%).〈/p〉
Keywords:
Thyroid ; Aspiration ; Algorithm ; Medullary carcinoma ; Thyroid ; Aspiration ; Algorithm ; Medullary Carcinoma
ISSN:
0387-1193
E-ISSN:
18827233
DOI:
10.5795/jjscc.57.151
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