在甲状腺细针穿刺细胞学报告的 Bethesda 系统中，不典型或意义不明确的滤泡性病变患者中，重复细针抽吸活检的产量和恶性肿瘤的发生率。
Yield of repeat fine-needle aspiration biopsy and rate of malignancy in patients with atypia or follicular lesion of undetermined significance: the impact of the Bethesda System for Reporting Thyroid Cytopathology.
机构信息
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA.
出版信息
Surgery. 2012 Dec;152(6):1037-44. doi: 10.1016/j.surg.2012.08.052. Epub 2012 Oct 3.
BACKGROUND
Atypia/follicular lesion of undetermined significance (A/FLUS) is a new category in the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) for which repeat fine-needle aspiration biopsy (FNAB) is recommended.
METHODS
A retrospective review was completed to evaluate the impact of the BSRTC on management of nodular thyroid disease. Patients were divided into pre-BSRTC and BSRTC groups. A comparative analysis of cytopathologic diagnoses and rates of repeat FNAB and malignancy was completed.
RESULTS
FNAB was performed in 730 patients: 337 pre-BSRTC and 393 BSRTC. There was a decrease in follicular/Hürthle cell neoplasm (FN/HCN; 9.5% vs 3.6%, P = .001) but no difference in the rate of malignancy (6.5% vs 6.4%, P = 1.0). Fewer operations (29% vs 21%, P = .02) and more repeat FNABs (3.9% vs 11%, P < .001) were performed in the BSRTC group. Sixty-one (16%) patients had A/FLUS, 56 with complete follow-up. Repeat FNAB in 26 patients was benign (11), A/FLUS (6), suspicious for malignancy (4), FN/HCN (2), and nondiagnostic (3). Thirty-two (57%) patients underwent thyroidectomy, and 6 patients (19%) were diagnosed with cancer.
CONCLUSION
The BSRTC resulted in more frequent repeat FNAB, fewer thyroidectomies and no change in malignancy rate. In patients with A/FLUS, repeat FNAB was definitive in 65% with a rate of malignancy of 19%.
背景
不典型/滤泡性病变意义未明（A/FLUS）是甲状腺细胞病理学报告 Bethesda 系统（BSRTC）中的一个新类别，建议对其进行重复细针抽吸活检（FNAB）。
方法
对 BSRTC 对结节性甲状腺疾病管理的影响进行了回顾性研究。患者分为 BSRTC 前组和 BSRTC 组。对细胞学诊断和重复 FNAB 及恶性肿瘤的发生率进行了比较分析。
结果
共对 730 例患者进行了 FNAB：337 例 BSRTC 前组和 393 例 BSRTC 组。滤泡/Hurthle 细胞肿瘤（FN/HCN）的发生率下降（9.5% vs 3.6%，P =.001），但恶性肿瘤的发生率无差异（6.5% vs 6.4%，P = 1.0）。BSRTC 组的手术次数减少（29% vs 21%，P =.02），重复 FNAB 增加（3.9% vs 11%，P <.001）。61 例（16%）患者为 A/FLUS，56 例有完整的随访资料。26 例重复 FNAB 为良性（11 例）、A/FLUS（6 例）、可疑恶性（4 例）、FN/HCN（2 例）和非诊断性（3 例）。32 例（57%）患者行甲状腺切除术，6 例（19%）患者诊断为癌症。
结论
BSRTC 导致重复 FNAB 更频繁，甲状腺切除术减少，但恶性肿瘤发生率无变化。在 A/FLUS 患者中，重复 FNAB 可明确诊断 65%，恶性肿瘤发生率为 19%。
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