Jing Xin, Michael Claire W, Pu Robert T
Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109-0054, USA.
Diagn Cytopathol. 2008 Mar;36(3):161-6. doi: 10.1002/dc.20762.
The study was aimed to investigate the impact of using standard criteria for assessing specimen adequacy and diagnostic terminology (CAST) on fine-needle aspiration (FNA) diagnosis and clinical management of thyroid nodules. The study included similar numbers of FNAs performed in 2 year before (group A) and 1.5 year after (group B) implementing the standard CAST. In comparison to group A, group B showed a significantly lower rate of nondiagnostic specimens (RND) (16.1% vs. 21.6%, P <or= 0.01) and rate of descriptive diagnoses (RDD) (3.8% vs. 14.5%, P <or= 0.001) and greater non-neoplastic (70.0% vs. 64.1%, P<0.05) and follicular cell lesions (7.4% vs. 4.3%, P<0.05) but a similar percentage of neoplastic diagnoses. The rate of surgical follow-up (RSF) was significantly higher in group B than in group A, overall (21.6% vs. 17.0%, P<0.05), or in subgroups of non-neoplastic (12.6% vs. 5.4%, P<0.01) and neoplastic categories (81.0% vs. 61.0%, P<0.05). The rate of cytohistologic concordance was higher in group B although the difference was not statistically significant. We concluded that use of the standard CAST on FNA diagnosis of thyroid nodules significantly reduced RND and RDD, providing more consistent diagnoses among the pathologists as well as better and more uniform communication between the pathologists and the clinicians. Furthermore, the cytohistological concordance was slightly better after CAST implementation, indicating that the improvement of diagnostic consistency among pathologists did not sacrifice the diagnostic accuracy.
本研究旨在调查使用标准标准评估标本充足性和诊断术语（CAST）对甲状腺结节细针穿刺（FNA）诊断及临床管理的影响。该研究纳入了在实施标准CAST之前2年（A组）和之后1.5年（B组）进行的数量相似的FNA。与A组相比，B组的非诊断性标本率（RND）显著降低（16.1%对21.6%，P≤0.01），描述性诊断率（RDD）也显著降低（3.8%对14.5%，P≤0.001），非肿瘤性病变（70.0%对64.1%，P<0.05）和滤泡细胞病变（7.4%对4.3%，P<0.05）比例更高，但肿瘤性诊断的比例相似。B组的手术随访率（RSF）总体上显著高于A组（21.6%对17.0%，P<0.05），在非肿瘤性亚组（12.6%对5.4%，P<0.01）和肿瘤性亚组（81.0%对61.0%，P<0.05）中也是如此。B组的细胞组织学一致性率更高，尽管差异无统计学意义。我们得出结论，在甲状腺结节FNA诊断中使用标准CAST可显著降低RND和RDD，使病理学家之间的诊断更加一致，同时改善病理学家与临床医生之间的沟通，使其更好、更统一。此外，实施CAST后细胞组织学一致性略有改善，表明病理学家之间诊断一致性的提高并未牺牲诊断准确性。
