Division of GI Endocrine Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9156, USA.
Surgery. 2010 Dec;148(6):1267-72; discussion 1272-3. doi: 10.1016/j.surg.2010.09.017.
Cytologically indeterminate thyroid nodules represent a diagnostic and therapeutic challenge. In 2007, the National Cancer Institute recommended The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) as a means of improving the accuracy of thyroid cytopathology. Our objective was to determine the effect of TBSRTC on thyroidectomy rates and malignancy risk in cytologically indeterminate lesions.
We compared thyroidectomy rates and malignancy risk in patients with indeterminate thyroid cytopathology across 2 time periods, spanning January 2000 and November 2009; pre-TBSRTC (January 2000 to September 2003) and post-TBSRTC (June 2008 to November 2009). Statistical comparisons were performed using the Fisher's exact test and chi-square analysis (P = .05 significant).
We performed 938 fine-needle aspirations in the first period, 765 in the second. We identified 78 (8.3%) cytologically indeterminate lesions in the pre-TBSRTC group and 91 (11.9%) lesions in the post-TBSRTC group. We found no difference in thyroidectomy rates between the groups (37/78 [47%] pre-Bethesda versus 32/91 [35%] post-Bethesda; P = .12). However, the malignancy rate was significantly lower in the post-TBSRTC group (13/37 [35%] pre-Bethesda versus 4/32 [13%] post-Bethesda; P = .02).
Application of TBSRTC is associated with lower malignancy risk in indeterminate thyroid nodules, despite similar thyroidectomy rates. These findings imply that standardization of cytologic classification improves diagnostic accuracy.
细胞学不确定的甲状腺结节是一个诊断和治疗的挑战。2007 年，美国国家癌症研究所推荐使用甲状腺细胞病理学报告的 Bethesda 系统（TBSRTC）作为提高甲状腺细胞学诊断准确性的一种方法。我们的目的是确定 TBSRTC 对细胞学不确定的病变行甲状腺切除术的比率和恶性风险的影响。
我们比较了 2000 年 1 月至 2009 年 11 月期间两个时期的细胞学不确定甲状腺病变的甲状腺切除术率和恶性风险；TBSRTC 之前（2000 年 1 月至 2003 年 9 月）和 TBSRTC 之后（2008 年 6 月至 2009 年 11 月）。使用 Fisher 精确检验和卡方分析进行统计学比较（P =.05 有统计学意义）。
我们在第一个时期进行了 938 例细针抽吸，在第二个时期进行了 765 例。我们在 TBSRTC 前组中发现了 78 例（8.3%）细胞学不确定的病变，在 TBSRTC 后组中发现了 91 例（11.9%）病变。我们发现两组之间的甲状腺切除术率没有差异（37/78 [47%] TBSRTC 前组与 32/91 [35%] TBSRTC 后组；P =.12）。然而，TBSRTC 后组的恶性率明显较低（37/78 [47%] TBSRTC 前组与 32/91 [35%] TBSRTC 后组；P =.12）。
应用 TBSRTC 与不确定甲状腺结节的恶性风险降低相关，尽管甲状腺切除术率相似。这些发现表明细胞分类的标准化提高了诊断的准确性。
