Pyo J-S, Sohn J H, Kang G
Department of Pathology, Eulji University Hospital, Daejeon, Republic of Korea.
Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunanro, Jongno-gu, Seoul, 03181, Republic of Korea.
J Endocrinol Invest. 2017 Mar;40(3):305-311. doi: 10.1007/s40618-016-0563-0. Epub 2016 Oct 19.
The aim of this study was to elucidate the cytological characteristics and the diagnostic usefulness of intraoperative cytology (IOC) for papillary thyroid carcinoma (PTC). In addition, using decision tree analysis, effective features for accurate cytological diagnosis were sought.
We investigated cellularity, cytological features and diagnosis based on the Bethesda System for Reporting Thyroid Cytopathology in IOC of 240 conventional PTCs. The cytological features were evaluated in terms of nuclear score with nuclear features, and additional figures such as presence of swirling sheets, psammoma bodies, and multinucleated giant cells. The nuclear score (range 0-7) was made via seven nuclear features, including (1) enlarged, (2) oval or irregularly shaped nuclei, (3) longitudinal nuclear grooves, (4) intranuclear cytoplasmic pseudoinclusion, (5) pale nuclei with powdery chromatin, (6) nuclear membrane thickening, and (7) marginally placed micronucleoli.
Nuclear scores in PTC, suspicious for malignancy, and atypia of undetermined significance cases were 6.18 ± 0.80, 4.48 ± 0.82, and 3.15 ± 0.67, respectively. Additional figures more frequent in PTC than in other diagnostic categories were identified. Cellularity of IOC significantly correlated with tumor size, nuclear score, and presence of additional figures. Also, IOCs with higher nuclear scores (4-7) significantly correlated with larger tumor size and presence of additional figures. In decision tree analysis, IOCs with nuclear score >5 and swirling sheets could be considered diagnostic for PTCs.
Our study suggests that IOCs using nuclear features and additional figures could be useful with decreasing the likelihood of inconclusive results.
本研究旨在阐明术中细胞学检查（IOC）对甲状腺乳头状癌（PTC）的细胞学特征及诊断价值。此外，通过决策树分析，寻找有助于准确细胞学诊断的有效特征。
我们对240例传统PTC的IOC样本进行研究，依据甲状腺细胞病理学报告的贝塞斯达系统，调查细胞数量、细胞学特征及诊断情况。从细胞核特征评估细胞学特征，包括核评分以及其他特征，如漩涡状细胞片、砂粒体和多核巨细胞的存在情况。核评分（范围0 - 7）通过七个核特征得出，包括（1）核增大，（2）核呈椭圆形或不规则形，（3）核纵沟，（4）核内假包涵体，（5）核淡染伴粉末状染色质，（6）核膜增厚，（7）核仁靠边且微小。
PTC、可疑恶性及意义不明确的非典型病变病例的核评分分别为6.18±0.80、4.48±0.82和3.15±0.67。确定了PTC中比其他诊断类别更常见的其他特征。IOC的细胞数量与肿瘤大小、核评分及其他特征的存在显著相关。此外，核评分较高（4 - 7）的IOC与更大的肿瘤大小及其他特征的存在显著相关。在决策树分析中，核评分>5且有漩涡状细胞片的IOC可诊断为PTC。
我们的研究表明，利用核特征和其他特征的IOC有助于降低诊断结果不明确的可能性。
