甲状腺细胞病理学Bethesda报告系统用于甲状腺结节诊断临床研究
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摘要
目的评估甲状腺结节诊断中甲状腺细胞病理学Bethesda报告系统(TBSRTC)的临床应用及其特点。方法回顾性分析南京中医药大学附属中西医结合医院2009年5月至2013年12月行超声引导甲状腺细针穿刺(UG-FNA)的连续1667例涂片资料,并采用TBSRTC的6类分类诊断术语诊断。连续记录199例临床资料及其215个穿刺结节的大小。结果 1667例标本中,无法诊断有478例(28.7%),良性病变931例(55.8%),意义不明确的细胞非典型性病变114例(6.8%),可疑滤泡性肿瘤32例(1.9%),可疑恶性肿瘤69例(4.1%),恶性肿瘤31例(2.6%)。对记录大小的215个结节穿刺结果进行分析发现,最大直径小于0.5 cm的结节无法诊断率最高(64.3%),随着体积增大,良性结节的比例也显著增加,恶性结节的最大直径多见于0.5~2.0 cm。结论 TBSRTC有助于进一步规范临床甲状腺病理报告和甲状腺结节的处理。
Objective To investigate the clinical features of the Bethesda system for reporting thyroid cytopathology(TBSRTC) in the diagnosis of thyroid nodules. Methods A total of 1667 consecutive cases of thyroid fine needle aspiration(FNA) records interpretated according to TBSRTC during the period from May 2009 to December 2013 were retrospectively reviewed. Clinical data of 199 consecutive patients and the size of their 215 nodules were recorded. Results The 1667 FNAs results included 28.7% non-diagnostic, 55.8% benign, 6.8% atypical follicular lesion of undetermined significance(AUS), 1.9% suspicious for follicular neoplasm(FN), 4.1% suspicious for malignancy(SM), and 2.6% malignant. Further analysis on nodule size showed that the rate of non-diagnostic FNA lesion was the highest(64.3%) in nodules with maximal diameter <0.5 cm. The rate of benign FNA lesion increased with its size. The maximal diameter of most suspicious for malignancy and malignancy FNA lesions was in the range of 0.5-2.0 cm. Conclusions The Bethesda system standardizes the report of thyroid cytopathology and assists in the management approaches of thyroid nodule.
Objective To investigate the clinical features of the Bethesda system for reporting thyroid cytopathology(TBSRTC) in the diagnosis of thyroid nodules. Methods A total of 1667 consecutive cases of thyroid fine needle aspiration(FNA) records interpretated according to TBSRTC during the period from May 2009 to December 2013 were retrospectively reviewed. Clinical data of 199 consecutive patients and the size of their 215 nodules were recorded. Results The 1667 FNAs results included 28.7% non-diagnostic, 55.8% benign, 6.8% atypical follicular lesion of undetermined significance(AUS), 1.9% suspicious for follicular neoplasm(FN), 4.1% suspicious for malignancy(SM), and 2.6% malignant. Further analysis on nodule size showed that the rate of non-diagnostic FNA lesion was the highest(64.3%) in nodules with maximal diameter <0.5 cm. The rate of benign FNA lesion increased with its size. The maximal diameter of most suspicious for malignancy and malignancy FNA lesions was in the range of 0.5-2.0 cm. Conclusions The Bethesda system standardizes the report of thyroid cytopathology and assists in the management approaches of thyroid nodule.
引文
[1]Bose S,Walts AE.Thyroid fine needle aspirate:a post-Bethesda update[J].Adv Anat Pathol,2012,19:160-169.
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[3]Haugen BR,Alexander EK,Bible KC,et al.2015 American Thyroid A ssociation Management Guidelines for Adult Patients with Thyroid Nodulesand Differentiated Thyroid Cancer:The American Thyroid Association Guidelines Task Force on Thyroid Nodulesand Differentiated Thyroid Cancer[J].Thyroid,2016,26(1):1-133.
[4]中华医学会内分泌学分会,中华医学会外科学分会内分泌学组,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中华内分泌代谢杂志,2012,28(10):779-797.
[5]徐书杭,陈国芳,褚晓秋,等.2011-2012年甲状腺领域的研究进展[J].中华内分泌代谢杂志,2013,29(2):97-101.
[6]Ozluk Y,Pehlivan E,Gulluoglu MG,et al.The use of the Bethesda terminology in thyroid fine-needle aspiration results in a lower rate of surgery for nonmalignant nodules:a report from a reference centerin Turkey[J].Int J Surg Pathol,2011,19(6):761-771.
[7]Crowe A,Linder A,Hameed O,et al.The impact of implementation of the Bethesda System for Reporting Thyroid Cytopathology on the quality of reporting,“risk”of malignancy,surgical rate,and rate of frozen sections requested for thyroid lesions[J].Cancer Cytopathol,2011,119(5):315-321.
[8]Jo VY,Stelow EB,Dustin SM,et al.Malignancy risk for fine-needle aspiration of thyroid lesionsaccording to the Bethesda system for reporting thyroid cytopathology[J].Am J Clin Pathol,2010,134(4):450-456.
[9]Yassa L,Cibas ES,Benson CB,et al.Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation[J].Cancer,2007,111(6):508-516.
[10]Ali SZ.甲状腺细胞病理学Bethesda报告系统:定义、标准和注释[M].杨斌,译.北京;北京科学技术出版社,2010.
[11]Park JH,Yoon SO,Son EJ,et al.Incidence and malignancy rates of diagnoses in The Bethesda system for reporting thyroid aspiration cytology:an institutional experience[J].Korean J Pathol,2014,48(2):133-139.
[12]Kiernan CM,Broome JT,Solórzano CC.The Bethesda system for reporting thyroid cytopathology:a single-center experience over 5years[J].Ann Surg Oncol,2014,21(11):3522-3527.
[13]刘超,姚青.实用甲状腺细针穿刺诊疗术[M].北京:人民卫生出版社,2014.
[14]Yu XM,Lloyd R,Chen H.Current treatment of papillary thyroid microcarcinoma[J].Adv Surg,2012,46:191-203.
[15]Pacini F.Thyroid microcarcinoma[J].Best Pract Res Clin Endocrinol Metab,2012,26(3):381-389.
[16]Bongiovanni M,Spitale A,Faquin WC,et al.The Bethesda System for Reporting Thyroid Cytopathology:a meta-analysis[J].Acta Cytol,2012,56(4):333-339.
[2]American Thyroid Association(ATA)Guidelines Taskforce on Thyroid Nodulesand Differentiated Thyroid Cancer,Cooper DS,Doherty GM,et al.Revised American Thyroid Association management guidelines for patients with thyroid nodulesand differentiated thyroid cancer[J].Thyroid,2009,19(11):1167-1214.
[3]Haugen BR,Alexander EK,Bible KC,et al.2015 American Thyroid A ssociation Management Guidelines for Adult Patients with Thyroid Nodulesand Differentiated Thyroid Cancer:The American Thyroid Association Guidelines Task Force on Thyroid Nodulesand Differentiated Thyroid Cancer[J].Thyroid,2016,26(1):1-133.
[4]中华医学会内分泌学分会,中华医学会外科学分会内分泌学组,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中华内分泌代谢杂志,2012,28(10):779-797.
[5]徐书杭,陈国芳,褚晓秋,等.2011-2012年甲状腺领域的研究进展[J].中华内分泌代谢杂志,2013,29(2):97-101.
[6]Ozluk Y,Pehlivan E,Gulluoglu MG,et al.The use of the Bethesda terminology in thyroid fine-needle aspiration results in a lower rate of surgery for nonmalignant nodules:a report from a reference centerin Turkey[J].Int J Surg Pathol,2011,19(6):761-771.
[7]Crowe A,Linder A,Hameed O,et al.The impact of implementation of the Bethesda System for Reporting Thyroid Cytopathology on the quality of reporting,“risk”of malignancy,surgical rate,and rate of frozen sections requested for thyroid lesions[J].Cancer Cytopathol,2011,119(5):315-321.
[8]Jo VY,Stelow EB,Dustin SM,et al.Malignancy risk for fine-needle aspiration of thyroid lesionsaccording to the Bethesda system for reporting thyroid cytopathology[J].Am J Clin Pathol,2010,134(4):450-456.
[9]Yassa L,Cibas ES,Benson CB,et al.Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation[J].Cancer,2007,111(6):508-516.
[10]Ali SZ.甲状腺细胞病理学Bethesda报告系统:定义、标准和注释[M].杨斌,译.北京;北京科学技术出版社,2010.
[11]Park JH,Yoon SO,Son EJ,et al.Incidence and malignancy rates of diagnoses in The Bethesda system for reporting thyroid aspiration cytology:an institutional experience[J].Korean J Pathol,2014,48(2):133-139.
[12]Kiernan CM,Broome JT,Solórzano CC.The Bethesda system for reporting thyroid cytopathology:a single-center experience over 5years[J].Ann Surg Oncol,2014,21(11):3522-3527.
[13]刘超,姚青.实用甲状腺细针穿刺诊疗术[M].北京:人民卫生出版社,2014.
[14]Yu XM,Lloyd R,Chen H.Current treatment of papillary thyroid microcarcinoma[J].Adv Surg,2012,46:191-203.
[15]Pacini F.Thyroid microcarcinoma[J].Best Pract Res Clin Endocrinol Metab,2012,26(3):381-389.
[16]Bongiovanni M,Spitale A,Faquin WC,et al.The Bethesda System for Reporting Thyroid Cytopathology:a meta-analysis[J].Acta Cytol,2012,56(4):333-339.