Manning Amy M, Yang Huaitao, Falciglia Mercedes, Mark Jonathan R, Steward David L
1 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA.
2 Department of Pathology and Laboratory Medicine. University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA.
Otolaryngol Head Neck Surg. 2017 Apr;156(4):611-615. doi: 10.1177/0194599816688190. Epub 2017 Jan 24.
Objectives To evaluate changes in distribution of reported thyroid nodule fine-needle aspiration (FNA) cytopathology results since implementation of the Bethesda classification and revised 2015 American Thyroid Association (ATA) guidelines for selecting nodules for biopsy. Study Design Retrospective review. Setting Tertiary academic medical center. Subjects and Methods Evaluation of ultrasound (US)-guided thyroid FNA by a single surgeon using 2015 ATA nodule selection criteria and Bethesda reporting on 211 thyroid nodules in a 1-year period (2015). Comparison is made to an earlier sample wherein any nodule >1 cm underwent US FNA with cytology reported prior to Bethesda consensus (2006). Results The current cohort involved mostly women (79%); nodules ranged from 1 to 7 cm (mean ± SEM, 2.4 ± 0.07 cm). Mean ± SEM age was 53.5 ± 1.1 years. Bethesda reporting yielded 6% nondiagnostic, 57% benign, 3% malignant, and 34% indeterminate (27% atypia of undetermined significance [AUS]/follicular lesion of undetermined significance [FLUS], 4% follicular neoplasm [FN]/Hürthle neoplasm [HN], and 2% suspicious for malignancy [SFM]). The malignancy rate in indeterminate nodules was 26% (18% AUS/FLUS, 33% FN/HN, and 80% SFM). Age, sex, or nodule size did not correlate with indeterminate cytology. The comparator sample of 447 nodules had significantly different distribution, with 7% nondiagnostic, 80% benign, 5% malignant, and 8% indeterminate ( P < .00001). Conclusion We observed a significantly increased proportion of indeterminate cytology and corresponding decrease in benign nodules compared with an earlier sample, predominately from an increase in AUS/FLUS. Multiple factors are likely involved, including selection of sonographically suspicious nodules for biopsy based upon 2015 ATA guidelines coupled with cytopathological interpretation by a new generation of cytopathologists trained in the era of Bethesda reporting; further study is required to make a definitive conclusion.
目的 评估自实施贝塞斯达分类法及2015年美国甲状腺协会（ATA）修订的甲状腺结节活检选择指南以来，报告的甲状腺结节细针穿刺（FNA）细胞病理学结果分布的变化。研究设计 回顾性研究。研究地点 三级学术医学中心。研究对象与方法 由一名外科医生使用2015年ATA结节选择标准对超声（US）引导下的甲状腺FNA进行评估，并按照贝塞斯达分类法对1年期间（2015年）的211个甲状腺结节进行报告。与一个早期样本进行比较，在该早期样本中，任何直径>1 cm的结节均接受了US FNA，并在贝塞斯达共识（2006年）之前报告了细胞学结果。结果 当前队列主要为女性（79%）；结节大小范围为1至7 cm（均值±标准误，2.4±0.07 cm）。平均±标准误年龄为53.5±1.1岁。贝塞斯达分类报告显示，6%为无法诊断，57%为良性，3%为恶性，34%为不确定（27%意义不明确的非典型性[AUS]/意义不明确的滤泡性病变[FLUS]，4%滤泡性肿瘤[FN]/许特耳细胞瘤[HN]，2%恶性可疑[SFM]）。不确定结节中的恶性率为26%（18% AUS/FLUS，33% FN/HN，80% SFM）。年龄、性别或结节大小与不确定的细胞学结果无关。447个结节的对照样本分布显著不同，无法诊断的为7%，良性的为80%，恶性的为5%，不确定的为8%（P<0.00001）。结论 与早期样本相比，我们观察到不确定细胞学结果的比例显著增加，良性结节相应减少，主要是由于AUS/FLUS的增加。可能涉及多种因素，包括根据2015年ATA指南选择超声可疑结节进行活检，以及由在贝塞斯达报告时代接受培训的新一代细胞病理学家进行细胞病理学解释；需要进一步研究以得出明确结论。
