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非侵袭性滤泡性甲状腺肿瘤伴乳头状核特征(NIFTP):对甲状腺细胞病理学报告的 Bethesda 系统(TBSRTC)中恶性肿瘤风险(ROM)的影响。

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): Implications for the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC).

机构信息

Department of Pathology, Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.

Department of Pathology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

Cancer Cytopathol. 2018 Jan;126(1):20-26. doi: 10.1002/cncy.21926. Epub 2017 Sep 20.

Abstract

BACKGROUND

The introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) affects the risk of malignancy (ROM) mostly in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories. In this multi-institutional, retrospective study, the authors investigated variations in the impact of an NIFTP diagnosis on the associated ROM for each TBSRTC category with an emphasis on the influence of pathologist and institutional diagnostic thresholds on the ROM.

METHODS

Baseline data on cytology and histology diagnostic categories were collected over a 3-year period at 3 academic center hospitals (institutions A, B, and C). Histology slides for all cases diagnosed as follicular variant of papillary thyroid carcinoma (FVPTC) were re-reviewed at each institution, and those that qualifying as NIFTP were separated from other PTCs.

RESULTS

The collective case cohort from the 3 institutions included 15,973 thyroid fine-needle aspiration cytology (FNAC) specimens and 5090 thyroid surgical resection specimens. Significant differences in baseline cytology and histology data were noted among the 3 institutions. The number of cases classified as NIFTP compared with FVPTC was highly variable (institution A, 14%; institution B, 39%; and institution C, 12%). For 3250 resected thyroid nodules with a previous FNAC diagnosis, the average decrease in ROM after the exclusion of NIFTP for all TBSRTC categories was as follows: institution A, 9.8%; institution B, 3.9%; and institution C, 1.3%.

CONCLUSIONS

The institutional frequency of NIFTP histopathology diagnosis and cytology baseline data will impact the ROM associated with specific FNAC diagnoses, especially among the indeterminate TBSRTC categories. The range of ROM for each TBSRTC diagnostic category is reflective of the inherent diagnostic thresholds and interobserver and interinstitutional variability in the diagnosis of thyroid lesions. Cancer Cytopathol 2018;126:20-6. © 2017 American Cancer Society.

摘要

背景

非侵袭性滤泡性甲状腺肿瘤伴乳头状核特征(NIFTP)的引入主要影响了 Bethesda 甲状腺细胞病理学报告系统(TBSRTC)分类中的恶性肿瘤风险(ROM)。在这项多机构、回顾性研究中,作者研究了 NIFTP 诊断对每个 TBSRTC 分类相关 ROM 的影响变化,重点研究了病理学家和机构诊断阈值对 ROM 的影响。

方法

在 3 年期间,从 3 家学术中心医院(机构 A、B 和 C)收集细胞学和组织学诊断类别的基线数据。对所有诊断为甲状腺滤泡状癌变异型(FVPTC)的组织学切片在每个机构进行重新审查,将符合 NIFTP 的病例与其他 PTC 分开。

结果

来自 3 个机构的集体病例队列包括 15973 例甲状腺细针抽吸细胞学(FNAC)标本和 5090 例甲状腺切除术标本。3 家机构的基线细胞学和组织学数据存在显著差异。与 FVPTC 相比,NIFTP 病例数量差异很大(机构 A,14%;机构 B,39%;机构 C,12%)。在 3250 例有之前 FNAC 诊断的甲状腺结节切除中,在排除所有 TBSRTC 分类的 NIFTP 后,ROM 的平均下降如下:机构 A,9.8%;机构 B,3.9%;机构 C,1.3%。

结论

机构中 NIFTP 组织病理学诊断和细胞学基线数据的频率将影响与特定 FNAC 诊断相关的 ROM,尤其是在不确定的 TBSRTC 分类中。每个 TBSRTC 诊断类别的 ROM 范围反映了甲状腺病变诊断中的固有诊断阈值以及观察者间和机构间的变异性。癌症细胞病理学 2018;126:20-6。©2017 美国癌症协会。

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