Richmond Bryan K, O'Brien Bridget A, Mangano William, Thompson Stephanie, Kemper Suzanne
West Virginia University/Charleston Division, Charleston, West Virginia, USA.
Am Surg. 2012 Jun;78(6):706-10.
Published data suggest that the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) is valuable in directing therapy of thyroid nodules. Literature examining the effect of the BSRTC on management when compared with pre BSRTC is lacking, however. This study evaluates the impact of applying the BSRTC retrospectively to a series of patients who underwent surgery after a fine-needle aspiration biopsy (FNAB) classified using the pre BSRTC system, and investigates how the BSRTC application to the same population would have ultimately affected the management strategy. One hundred patients who had previously undergone both FNAB and thyroidectomy before implementation of the BSRTC were randomly selected. Each FNAB was examined by a single cytopathologist (blinded to both the original interpretation and the surgical pathology findings) and reclassified using the BSRTC. Accuracy of both systems was examined using the final pathology as the true diagnosis. Of 68 FNABs initially classified as indeterminate, 32 (47.1%) were reclassified as benign. There was no significant difference in overall rates of detection of malignancy on final pathology in specimens classified as benign, both pre and post application of the BSRTC (P = 0.70). Application of the BSRTC resulted in a significant percentage of indeterminate specimens being reclassified as benign, presumably due to more standardized criteria for interpretation and reporting. No significant change in detection of malignancy was observed. We conclude that application of the BSRTC may result in lower rates of thyroidectomy, while preserving the same diagnostic accuracy in the detection of thyroid malignancy.
已发表的数据表明，甲状腺细胞病理学报告的贝塞斯达系统（BSRTC）在指导甲状腺结节的治疗方面具有重要价值。然而，与BSRTC之前相比，研究BSRTC对管理影响的文献却很缺乏。本研究回顾性评估了将BSRTC应用于一系列在使用BSRTC之前的系统进行细针穿刺活检（FNAB）分类后接受手术的患者的影响，并调查了将BSRTC应用于同一人群最终会如何影响管理策略。随机选择了100名在BSRTC实施之前既接受过FNAB又接受过甲状腺切除术的患者。每例FNAB由一名细胞病理学家进行检查（对原始诊断和手术病理结果均不知情），并使用BSRTC重新分类。以最终病理结果作为真实诊断来检查两个系统的准确性。在最初分类为不确定的68例FNAB中，有32例（47.1%）被重新分类为良性。在BSRTC应用前后，最终病理结果中分类为良性的标本在恶性肿瘤总体检出率上没有显著差异（P = 0.70）。BSRTC的应用导致相当比例的不确定标本被重新分类为良性，这可能是由于解释和报告的标准更加标准化。在恶性肿瘤的检出方面未观察到显著变化。我们得出结论，应用BSRTC可能会降低甲状腺切除术的发生率，同时在甲状腺恶性肿瘤的检测中保持相同的诊断准确性。
