Naz Samreen, Hashmi Atif Ali, Khurshid Amna, Faridi Naveen, Edhi Muhammad Muzzammil, Kamal Anwar, Khan Mehmood
Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Liaquat National Hospital and Medical College, Karachi, Pakistan.
Int Arch Med. 2014 Oct 31;7:46. doi: 10.1186/1755-7682-7-46. eCollection 2014.
Thyroid swelling is common problem among South Asian women. Although benign nodules far outnumber cancerous lesions, the risk of malignancy needs to be evaluated preoperatively for which fine needle aspiration cytology (FNAC) is widely used. Bethesda system for reporting thyroid cytopathology (BSRTC) was introduced to streamline the reporting of thyroid aspirates. We aimed to evaluate the disease spectrum of thyroid cytopathology and correlation of BSRTC with final histopathology in our setup.
The study was conducted at Histopathology department of Liaquat National Hospital, Karachi, involving 528 patients with thyroid swelling who underwent FNAC. Out of these 528 cases, 61 patients subsequently underwent surgical excision. Results of final histopathology were correlated with cytologic diagnosis.
Mean age of the patients included in the study was 39.7 ± 13(14-84) and male to female ratio was 1:3.6. Out of total 528 cases, 403 cases were diagnosed as benign (Bethesda 2) and 67 were Bethesda 3 (follicular lesion of undetermined significance, FLUS) while 22 cases were categorized as either malignant or suspicious for malignancy (Bethesda 6 and 5). Histopathologic correlation was done in 61 cases. For Bethesda 5 and 6 categories, 100% concordance was found, however for Bethesda 2 category, 5 out of 45 cases were found to have malignant diagnosis on final histopathology. The incidence of malignancy in Bethesda categories 2 through 4 were 11.1%, 33.4%, 25%, 100% and 100% respectively. Overall accuracy of FNA cytology was 80.3% with 64.3% sensitivity and 85.1% specificity.
Our study validated the accuracy of BSRTC in our setup. Therefore we recommend routine use of BSRTC for reporting thyroid cytopathology for initial workup of patients with thyroid nodule. However, risk of malignancy was found to be significantly high in Bethesda 3 category to warrant further workup including ultrasound/thyroid scan in addition to repeat FNAC.
甲状腺肿大是南亚女性的常见问题。尽管良性结节的数量远远超过癌性病变，但术前仍需评估恶性风险，为此细针穿刺细胞学检查（FNAC）被广泛应用。引入甲状腺细胞病理学报告的贝塞斯达系统（BSRTC）以规范甲状腺穿刺物的报告。我们旨在评估我们机构中甲状腺细胞病理学的疾病谱以及 BSRTC 与最终组织病理学的相关性。
该研究在卡拉奇利亚卡特国家医院组织病理学科室进行，纳入 528 例接受 FNAC 的甲状腺肿大患者。在这 528 例病例中，61 例随后接受了手术切除。最终组织病理学结果与细胞学诊断进行相关性分析。
纳入研究的患者平均年龄为 39.7 ± 13（14 - 84）岁，男女比例为 1:3.6。在总共 528 例病例中，403 例被诊断为良性（贝塞斯达 2 类），67 例为贝塞斯达 3 类（意义不明确的滤泡性病变，FLUS），而 22 例被归类为恶性或疑似恶性（贝塞斯达 6 类和 5 类）。对 61 例进行了组织病理学相关性分析。对于贝塞斯达 5 类和 6 类，一致性为 100%，然而对于贝塞斯达 2 类，45 例中有 5 例在最终组织病理学检查中被诊断为恶性。贝塞斯达 2 至 4 类中的恶性发生率分别为 11.1%、33.4%、25%、100%和 100%。FNA 细胞学检查的总体准确率为 80.3%，敏感性为 64.3%，特异性为 85.1%。
我们的研究验证了我们机构中 BSRTC 的准确性。因此，我们建议常规使用 BSRTC 报告甲状腺细胞病理学，用于甲状腺结节患者的初步检查。然而，发现贝塞斯达 3 类中的恶性风险显著较高，除了重复 FNAC 外，还需要进一步检查，包括超声/甲状腺扫描。
