Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Cancer Cytopathol. 2014 Aug;122(8):611-9. doi: 10.1002/cncy.21436. Epub 2014 May 28.
Second-opinion diagnosis (SOD) on pathological material is an accepted practice before definitive therapy is considered for referred patients. The thyroid gland is an anatomical site prone to diagnostic disagreement between pathologists. We performed a review of the literature that addressed the role of interinstitutional SOD on thyroid fine-needle aspirations (FNAs).
Nine studies comprising second opinions on thyroid FNAs were selected. The parameters analyzed included: discordances between the initial diagnoses (IDs) and SODs; cytohistologic correlation; changes in the clinical management of the patients with thyroid nodules after SOD. The same parameters were applied to the "indeterminate" diagnostic category comprising cases initially reported as "atypia," "atypia of undetermined significance/follicular lesion of undetermined significance," "suspicious for a follicular neoplasm," "follicular neoplasm," "suspicious," and "suspicious for malignancy."
A total of 7154 thyroid FNAs were retrieved, showing an overall discordance rate between ID and SOD of 28.6%. In general, SOD was better supported by clinical follow-up and histological diagnosis, showing higher diagnostic accuracy in comparison with ID. Almost one-third (30.4%) of the discordant cases resulted in changes in the clinical management of patients with thyroid nodules. Numerous thyroid FNAs initially categorized as "indeterminate" were definitively classified as benign or malignant by SOD, with an overall diagnostic resolution rate of 42.5%, sensitivity of 97.9%, and diagnostic accuracy of 73.7%.
Second-opinion review of thyroid FNA improves diagnostic accuracy and potentially changes clinical management. SOD also demonstrates a significative rate of diagnostic resolution for thyroid FNAs originally diagnosed as "indeterminate."
在考虑为转诊患者进行明确治疗之前，对病理材料进行二次诊断（SOD）是一种被接受的做法。甲状腺是一个容易在病理学家之间产生诊断分歧的解剖部位。我们对涉及甲状腺细针抽吸（FNA）的机构间 SOD 作用的文献进行了回顾。
选择了 9 项涉及甲状腺 FNA 二次诊断的研究。分析的参数包括：初始诊断（ID）与 SOD 之间的差异；细胞组织学相关性；SOD 后甲状腺结节患者临床管理的变化。同样的参数也适用于“不确定”诊断类别，包括最初报告为“不典型”、“不典型意义不明/滤泡性病变意义不明”、“可疑滤泡性肿瘤”、“滤泡性肿瘤”、“可疑”和“可疑恶性”的病例。
共检索到 7154 例甲状腺 FNA，ID 与 SOD 之间的总体差异率为 28.6%。一般来说，SOD 得到了临床随访和组织学诊断的更好支持，与 ID 相比具有更高的诊断准确性。将近三分之一（30.4%）的不典型病例导致甲状腺结节患者的临床管理发生变化。许多最初归类为“不确定”的甲状腺 FNA 通过 SOD 被明确归类为良性或恶性，总体诊断分辨率为 42.5%，灵敏度为 97.9%，诊断准确性为 73.7%。
甲状腺 FNA 的二次诊断审查提高了诊断准确性，并可能改变临床管理。SOD 还显示出对最初诊断为“不确定”的甲状腺 FNA 的显著诊断分辨率率。
