Vivero Marina, Renshaw Andrew A, Krane Jeffrey F
Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Department of Pathology, Baptist Hospital, Miami, Florida.
Cancer Cytopathol. 2017 Jul;125(7):534-543. doi: 10.1002/cncy.21858. Epub 2017 Apr 7.
Adequacy criteria for thyroid fine-needle aspiration (FNA) recommended by The Bethesda System for Reporting Thyroid Cytopathology (TBS) were developed with smears, but they are commonly applied to ThinPreps (TPs). This study evaluated adequacy in TPs at different diagnostic thresholds.
All FNA procedures performed between 2010 and 2015 with matched surgical specimens were analyzed. Cell counts and cytological features were evaluated in all initially nondiagnostic (ND) cases. ND cases were reclassified into TBS categories by 2 pathologists, and the results were compared with surgical outcomes.
One hundred forty-six of the 151 cases initially classified as ND were available for review, and they had a mean cell count of 60.5 (standard deviation, 71.4). Interobserver agreement on the reclassification of ND cases was moderate (k = 0.57), and consensus yielded 48 ND cases (33%), 72 benign cases (49%), 24 cases of atypia of undetermined significance (16%), and 2 cases suspicious for malignancy (1%). Lowering the diagnostic threshold to any follicular cells yielded a sensitivity of 92%, a specificity of 60%, a positive predictive value of 59%, a negative predictive value of 92%, and a false-negative rate of 7.7%, whereas the values for the initially diagnostic cases were 93%, 58%, 59%, 93%, and 7.7%, respectively. Including cases with >60 cells but lacking 6 groups containing at least 10 cells did not affect test performance. Nuclear enlargement, pallor, grooves, and the presence of histiocytoid cells in initially ND FNA correlated with malignancy.
In thyroid FNA examined with TP only, lowering the adequacy threshold and eliminating the requirement of 6 groups of at least 10 cells did not significantly affect test performance if cytological features associated with malignancy were absent. Cancer Cytopathol 2017;125:534-43. © 2017 American Cancer Society.
《贝塞斯达甲状腺细胞病理学报告系统》（TBS）推荐的甲状腺细针穿刺活检（FNA）充分性标准是基于涂片制定的，但目前通常应用于液基薄层制片（TP）。本研究评估了不同诊断阈值下TP的充分性。
分析了2010年至2015年间所有进行FNA且有匹配手术标本的病例。对所有最初诊断不明确（ND）的病例进行细胞计数和细胞学特征评估。由2名病理学家将ND病例重新分类为TBS类别，并将结果与手术结果进行比较。
最初分类为ND的151例病例中有146例可供复查，其平均细胞计数为60.5（标准差为71.4）。观察者间对ND病例重新分类的一致性为中等（k = 0.57），达成共识后有48例ND病例（33%）、72例良性病例（49%）、24例意义未明的非典型病变病例（16%）以及2例可疑恶性病例（1%）。将诊断阈值降低至任何滤泡细胞时，敏感性为92%，特异性为60%，阳性预测值为59%，阴性预测值为92%，假阴性率为7.7%，而最初诊断病例的相应值分别为93%、58%、59%、93%和7.7%。纳入细胞数>60但缺乏6组每组至少10个细胞的病例对检测性能无影响。最初ND的FNA中核增大、核淡染、核沟以及组织细胞样细胞的存在与恶性肿瘤相关。
在仅采用TP检查的甲状腺FNA中，如果不存在与恶性肿瘤相关的细胞学特征，降低充分性阈值并取消6组每组至少10个细胞的要求不会显著影响检测性能。《癌症细胞病理学》2017年；125：534 - 43。©2017美国癌症协会。
