Duggal Rajan, Rajwanshi Arvind, Gupta Nalini, Vasishta Rakesh Kumar
Department of Cytology and Gynecologic Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Diagn Cytopathol. 2011 Apr;39(4):235-41. doi: 10.1002/dc.21363.
The difficulty in correctly identifying follicular lesions/neoplasms (FN) of thyroid is a well recognized fact. The present study was undertaken to study the degree of interobserver variability among cytopathologists and histopathologists in the diagnosis of these lesions. A total of 74 cases were chosen with a cytological diagnosis varying from FN (43 cases), hürthle cell neoplasm (18 cases), neoplasm suspicious of papillary carcinoma (7 cases) and follicular variant of papillary carcinoma (FVPTC) (4 cases) and neoplasm, NOS (2 cases). All these cases were reviewed by a cytopathologist along with surgical follow-up. In cases of cytohistological discordance, histopathological diagnoses were also reviewed by a histopathologist. The accuracy of initial and reviewed cytology in predicting neoplastic histological outcome was 100%; however 15 cases were over-diagnosed on initial cytology as FN and on reviewed cytology, 8/15 cases were under-diagnosed as non-neoplastic; however still seven cases were over-diagnosed on reviewed cytology, thereby specificity for neoplastic histological outcome ranging from 50 to 68%. The histopathology diagnosis was reviewed and changed in six cases; therefore interobserver agreement among histopathologist is 92% which reduces further in diagnosis of FVPTC, as in two cases diagnosis of follicular adenoma was changed to FVPTC. Neoplastic follicular patterned lesions (FN) pose diagnostic difficulties among pathologists. So, all cases with a cytological diagnosis of FN should be reviewed along with histopathology to minimize interobserver variability and reviewed histopathology should be considered as "gold standard".
甲状腺滤泡性病变/肿瘤（FN）的准确识别存在困难，这是一个公认的事实。本研究旨在探讨细胞病理学家和组织病理学家在诊断这些病变时观察者间的变异程度。共选取了74例病例，其细胞学诊断包括FN（43例）、许特莱细胞肿瘤（18例）、可疑乳头状癌肿瘤（7例）、乳头状癌滤泡变体（FVPTC）（4例）和未另行特指的肿瘤（NOS）（2例）。所有这些病例均由细胞病理学家进行复查，并结合手术随访情况。在细胞组织学诊断不一致的病例中，组织病理学诊断也由组织病理学家进行复查。初始细胞学和复查细胞学在预测肿瘤组织学结果方面的准确性为100%；然而，15例病例在初始细胞学检查中被过度诊断为FN，在复查细胞学检查中，15例中有8例被误诊为非肿瘤性病变；不过，仍有7例在复查细胞学检查中被过度诊断，因此肿瘤组织学结果的特异性为50%至68%。6例病例的组织病理学诊断经过复查并有所改变；因此，组织病理学家之间的观察者间一致性为92%，在FVPTC的诊断中进一步降低，因为有2例滤泡性腺瘤的诊断被改为FVPTC。肿瘤性滤泡样病变（FN）给病理学家带来了诊断困难。所以，所有细胞学诊断为FN的病例都应结合组织病理学进行复查，以尽量减少观察者间的变异，并且复查后的组织病理学应被视为“金标准”。
