Kakudo Kennichi, Kameyama Kaori, Miyauchi Akira, Nakamura Hirotoshi
Department of Pathology, Nara Hospital Kinki University Faculty of Medicine, Ikoma 630-0293, Japan.
Endocr J. 2014;61(6):539-52. doi: 10.1507/endocrj.ej13-0494. Epub 2014 Apr 12.
The Japan Thyroid Association (JTA) recently published new guidelines for clinical management of thyroid nodules. This paper introduces their diagnostic system for reporting thyroid fine-needle aspiration cytology. There are two points where the new reporting system that differs from existing internationally-accepted ones. The first is the subclassification of the so-called indeterminate category, which is divided into 'follicular neoplasm' and 'others'. The second is the subclassification of follicular neoplasm into 'favor benign', 'borderline' and 'favor malignant'. It is characterized by self-explanatory terminologies as to histological type and probability of malignancy to establish further risk stratification as well as to facilitate communication between clinicians and cytopathologists. The different treatment strategies adopted for thyroid nodules is deeply influenced by the particular diagnostic system used for thyroid cytology. In Western countries all patients with follicular neoplasms are advised to have immediate diagnostic surgery while patients in Japan often undergo further risk stratification without immediate surgery. The JTA diagnostic system of reporting thyroid cytology is designed for further risk stratification of patients with indeterminate cytology. If a surgeon applies diagnostic lobectomy to all patients with follicular neoplasm unselectively, this subclassification of follicular neoplasm has no practical meaning and is unnecessary. Cytological risk stratification of follicular neoplasms is optional and cytopathologists can choose either a simple 6-tier system without stratification of follicular neoplasm or a complicated 8-tier system depending on their experience in thyroid cytology and clinical management.
日本甲状腺协会（JTA）最近发布了甲状腺结节临床管理的新指南。本文介绍了其甲状腺细针穿刺细胞学报告的诊断系统。新的报告系统与现有的国际公认系统有两点不同。第一点是对所谓的不确定类别进行细分，分为“滤泡性肿瘤”和“其他”。第二点是将滤泡性肿瘤细分为“倾向良性”“临界”和“倾向恶性”。其特点是组织学类型和恶性概率的术语具有自解释性，以建立进一步的风险分层，并促进临床医生和细胞病理学家之间的沟通。甲状腺结节所采用的不同治疗策略深受甲状腺细胞学特定诊断系统的影响。在西方国家，所有滤泡性肿瘤患者都被建议立即进行诊断性手术，而日本的患者通常会进行进一步的风险分层，而不立即手术。JTA甲状腺细胞学报告诊断系统旨在对不确定细胞学的患者进行进一步的风险分层。如果外科医生不加选择地对所有滤泡性肿瘤患者进行诊断性叶切除术，那么滤泡性肿瘤的这种细分就没有实际意义且没有必要。滤泡性肿瘤的细胞学风险分层是可选的，细胞病理学家可以根据他们在甲状腺细胞学和临床管理方面的经验，选择简单的无滤泡性肿瘤分层的6级系统或复杂的8级系统。
