基于细针抽吸细胞学和韩国甲状腺影像报告和数据系统的细胞学-超声风险分层评分系统。
Cytology-Ultrasonography Risk-Stratification Scoring System Based on Fine-Needle Aspiration Cytology and the Korean-Thyroid Imaging Reporting and Data System.
机构信息
1 Department of Radiology, Gachon University Gil Medical Center , Incheon, Korea.
2 Department of Radiology, Human Medical Imaging and Intervention Center , Seoul, Korea.
出版信息
Thyroid. 2017 Jul;27(7):953-959. doi: 10.1089/thy.2016.0603. Epub 2017 May 19.
BACKGROUND
The malignancy risk of a cytology diagnosis may depend on the ultrasonography (US) patterns of thyroid nodules, and management should be determined by the combined malignancy risk of fine-needle aspiration (FNA) cytology and US patterns. This study was performed to develop a clinically applicable cytology-ultrasonography (CU) scoring system for malignancy risk stratification based on FNA cytology and US patterns, according to the Korean-Thyroid Imaging Reporting and Data System (K-TIRADS).
METHODS
This retrospective Institutional Review Board-approved study included 1651 thyroid nodules (≥1 cm) with final diagnoses. The malignancy risk was assessed of the combined results of FNA cytology and the K-TIRADS for the development of the CU system. The interaction between FNA cytology and US pattern (K-TIRADS) in the malignancy risk of nodules was investigated by using a binominal test.
RESULTS
The malignancy risk of nodules could be stratified into four CU scores (very low risk, <3%; low risk, ≥3%, <30%; high risk, ≥30%, <90%; very high risk, ≥90%). In nodules with non-diagnostic, benign, and atypia of undetermined significance/follicular lesion of undetermined significance cytology results, low-suspicion US pattern (K-TIRADS 3) significantly decreased the malignancy risk of nodules (p = 0.003, 0.013, and 0.027, respectively), and a high-suspicion US pattern (K-TIRADS 5) significantly increased the malignancy risk of nodules (p ≤ 0.001). A Bethesda 1 or 4 cytology result did not significantly change the malignancy risk of any K-TIRADS (p ≥ 0.518 and p ≥ 0.137, respectively). A Bethesda 2 cytology result decreased and a Bethesda 5 or 6 cytology result increased the malignancy risk of K-TIRADS 3, 4, and 5 (p ≤ 0.001). A Bethesda 3 cytology result increased the malignancy risk of K-TIRADS 3 and 4 (p < 0.001 and p = 0.024, respectively).
CONCLUSION
The malignancy risk of thyroid nodules can be stratified by the CU risk-stratification system, based on FNA cytology and the K-TIRADS. The proposed CU scoring system may be helpful in the management of thyroid nodules after FNA.
背景
细胞学诊断的恶性风险可能取决于甲状腺结节的超声（US）模式，应根据细针抽吸（FNA）细胞学和 US 模式的联合恶性风险来确定治疗方案。本研究旨在根据韩国甲状腺成像报告和数据系统（K-TIRADS），基于 FNA 细胞学和 US 模式，为恶性风险分层开发一种临床适用的细胞学-超声（CU）评分系统。
方法
本回顾性机构审查委员会批准的研究纳入了最终诊断为 1651 个≥1cm 的甲状腺结节。通过对 FNA 细胞学和 K-TIRADS 的联合结果进行评估，确定 CU 系统的恶性风险。采用二项式检验研究 FNA 细胞学和 US 模式（K-TIRADS）在结节恶性风险中的相互作用。
结果
结节的恶性风险可分为四个 CU 评分（极低危，<3%；低危，≥3%，<30%；高危，≥30%，<90%；极高危，≥90%）。在非诊断性、良性和不确定意义的不典型/滤泡性病变不典型细胞学结果的结节中，低可疑度的 US 模式（K-TIRADS 3）显著降低了结节的恶性风险（p=0.003、0.013 和 0.027），而高度可疑的 US 模式（K-TIRADS 5）显著增加了结节的恶性风险（p≤0.001）。Bethesda 1 或 4 级细胞学结果并未显著改变任何 K-TIRADS 的恶性风险（p≥0.518 和 p≥0.137）。Bethesda 2 级细胞学结果降低，而 Bethesda 5 级或 6 级细胞学结果增加了 K-TIRADS 3、4 和 5 的恶性风险（p≤0.001）。Bethesda 3 级细胞学结果增加了 K-TIRADS 3 和 4 的恶性风险（p<0.001 和 p=0.024）。
结论
基于 FNA 细胞学和 K-TIRADS，甲状腺结节的恶性风险可以通过 CU 风险分层系统进行分层。所提出的 CU 评分系统可能有助于 FNA 后甲状腺结节的管理。
Zotero 插件