Department of Otorhinolaryngology-Head & Neck Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, 463-707, South Korea.
Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Endocr Pathol. 2017 Sep;28(3):247-252. doi: 10.1007/s12022-017-9486-3.
Within the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), category III (atypia or follicular lesion of undetermined significance (AUS/FLUS)) comprises specimens with heterogeneous features and the need for subcategorization has been reported. We compared the clinical features of two subgroups from within the category of AUS/FLUS to determine precise guidelines for clinicians who explain the results of fine-needle aspiration (FNA) to patients. Retrospective review was performed including data from all patients who underwent FNA with results reported as AUS/FLUS at a single tertiary hospital from January 2010 to August 2014. The results of repeated FNA, core needle biopsy, and diagnostic surgery were analyzed. Of the 903 patients with results categorized as AUS/FLUS, 500 were subcategorized as cellular atypia and 160 as architectural atypia. On repeated biopsy, diagnostic results were obtained for 78.9% patients of the cellular atypia group, compared to only 54.3% of the architectural atypia group (p < 0.0001). The rate of neoplasm or malignancy was also significantly higher in the cellular atypia group compared to the architectural atypia group (51.8 vs. 25.2%, p < 0.0001, 48.2 vs. 14.2%, p < 0.0001). Therefore, clinicians can inform patients with architectural atypia that the risk of malignancy is low. However, the high rate of non-diagnostic results on repeated biopsy makes clinical decisions difficult. The data of the present study revealed the necessity of subcategorization of category III of TBSRTC in the future.
在甲状腺细胞病理学报告的 Bethesda 系统（TBSRTC）中，类别 III（不典型或滤泡性意义未确定病变（AUS/FLUS））包括具有异质性特征的标本，并且已经报道需要进行细分。我们比较了 AUS/FLUS 类别内两个亚组的临床特征，以确定向患者解释细针抽吸（FNA）结果的临床医生的确切指导方针。回顾性研究包括 2010 年 1 月至 2014 年 8 月在一家三级医院接受 FNA 且结果报告为 AUS/FLUS 的所有患者的数据。分析了重复 FNA、核心针活检和诊断性手术的结果。在 903 例结果归类为 AUS/FLUS 的患者中，500 例细分为细胞异型性，160 例细分为结构异型性。在重复活检中，细胞异型性组的诊断结果获得了 78.9%的患者，而结构异型性组仅获得了 54.3%（p<0.0001）。与结构异型性组相比，细胞异型性组的肿瘤或恶性肿瘤发生率也明显更高（51.8%比 25.2%，p<0.0001，48.2%比 14.2%，p<0.0001）。因此，临床医生可以告知结构异型性患者恶性肿瘤的风险较低。然而，重复活检的非诊断结果率较高使得临床决策变得困难。本研究的数据揭示了未来 TBSRTC 类别 III 细分的必要性。
