Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
Cancer Cytopathol. 2011 Oct 25;119(5):315-21. doi: 10.1002/cncy.20174. Epub 2011 Jul 12.
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been anticipated to improve communication between pathologists and clinicians and thereby patient outcomes. In the current study, the impact of TBSRTC on various quality and outcome measures was assessed.
The current study included all patients who underwent fine-needle aspiration (FNA) of the thyroid between April 2006 and April 2009. Before implementation, the authors used generic diagnostic categories; after implementation, TBSRTC was used. Quality of reporting, diagnostic categories, rate of surgery, rates of frozen section, the "risk" of malignancy after a cytologic diagnosis, and errors before and after implementation of TBSRTC were compared using the chi-square and Fisher exact tests. Multilevel likelihood ratios and the receiver operating characteristic were used to compare the accuracy of FNA before and after implementation.
A total of 1671 FNAs (957 obtained before and 714 obtained after implementation of TBSRTC) were obtained from 1339 patients. Of these, 301 patients (191 before and 110 after implementation) underwent subsequent surgical resection. Before implementation, the reports were more ambiguous (3.7% vs 0.5%; P < .05) and implicit (5.1% vs 2.7%; P < .05) than after implementation. The overall rate of surgery decreased after implementation of TBSRTC (24.5% vs 19.6%; P < .05). The overall risk of malignancy did not appear to be affected by implementation of TBSRTC, but it decreased significantly after a benign FNA diagnosis compared with a diagnosis of an atypical lesion or follicular neoplasm. The rate of frozen section remained unchanged. The diagnostic accuracy was not found to be significantly different before compared with after implementation of TBSRTC.
Implementation of TBSRTC appears to improve the quality of reporting by lowering the number of ambiguous and implicit diagnoses and decreases the overall surgery rates, particularly for benign lesions, but it does not appear to have any effect on the accuracy of FNA of the thyroid, false-positive rates, or the frequency of intraoperative consultations.
甲状腺细胞病理学报告的贝塞斯达系统（TBSRTC）有望改善病理学家和临床医生之间的沟通，从而改善患者的结局。本研究评估了 TBSRTC 对各种质量和结局指标的影响。
本研究纳入了 2006 年 4 月至 2009 年 4 月间所有接受甲状腺细针抽吸（FNA）的患者。在实施 TBSRTC 之前，作者使用通用诊断类别；实施后，使用 TBSRTC。使用卡方检验和 Fisher 确切检验比较实施前后报告质量、诊断类别、手术率、冷冻切片率、细胞学诊断后恶性肿瘤的“风险”以及实施前后的错误。使用多水平似然比和接收者操作特征比较实施前后 FNA 的准确性。
共纳入 1339 例患者的 1671 例 FNA（实施 TBSRTC 前 957 例，实施后 714 例）。其中，301 例患者（实施前 191 例，实施后 110 例）接受了后续手术切除。实施前，报告比实施后更模糊（3.7%比 0.5%；P<0.05）和隐含（5.1%比 2.7%；P<0.05）。实施 TBSRTC 后手术率总体下降（24.5%比 19.6%；P<0.05）。实施 TBSRTC 后，恶性肿瘤的总体风险似乎并未受到影响，但良性 FNA 诊断后，恶性肿瘤的风险明显降低，而不典型病变或滤泡性肿瘤的诊断则无明显变化。冷冻切片率保持不变。实施 TBSRTC 前后诊断准确性无显著差异。
实施 TBSRTC 似乎通过降低模糊和隐含诊断的数量来提高报告质量，并降低总体手术率，特别是良性病变，但似乎对甲状腺 FNA 的准确性、假阳性率或术中咨询的频率没有任何影响。
