德国初级保健环境中细针穿刺细胞学检查的低恶性肿瘤率。

Low Malignancy Rates in Fine-Needle Aspiration Cytologies in a Primary Care Setting in Germany.

机构信息

1 Departments of Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada .

2 Divisions of Endocrinology and Nephrology, Department of Internal Medicine, Neurology, and Dermatology, University of Leipzig, Leipzig, Germany .

出版信息

Thyroid. 2017 Nov;27(11):1385-1392. doi: 10.1089/thy.2017.0167.

DOI:10.1089/thy.2017.0167

PMID:28982301

Abstract

BACKGROUND

Reported results for thyroid nodule fine-needle aspiration (FNA) cytology mainly originate from tertiary centers. However, thyroid nodule FNA cytology is mainly performed in primary care settings for which the distribution of FNA Bethesda categories and their respective malignancy rates are largely unknown. Therefore, this study investigated FNA cytology malignancy rates of a large primary care setting to determine to what extent current evidence-based strategies for the malignancy risk stratification of thyroid nodules are applied and applicable in such primary care settings.

METHODS

In a primary care setting, 9460 FNAs of thyroid nodules were retrospectively analyzed from 8380 patients evaluated by one cytologist (I.R.) during a period of two years. The 8380 FNA cytologies were performed by 64 physicians in different private practices throughout Germany in primary care settings.

RESULTS

The cytopathologic results were classified according to the Bethesda System as non-diagnostic in 19%, cyst/cystic nodule in 21%, benign (including thyroiditis) in 48%, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) in 6%, follicular neoplasms/suspicious for follicular neoplasm (FN/SFN) in 4%, suspicious for malignancy (SFM) in 1%, and malignant in 1%. The proportion of patients proceeding to surgery or with a follow-up of at least one year and the observed risks of malignancy were 22%/8% for AUS/FLUS, 69%/17% for FN/SFN, 78%/86% for SFM, and 71%/98% for malignant. For 112 cytologically suspicious and malignant FNAs, there were 102 true positives and 10 false positives, considering histology as gold standard.

CONCLUSION

At variance with other data mostly originating from tertiary centers, these data demonstrate low percentages for malignant, SFM, FN/SFN, and AUS/FLUS, and high percentages for cysts/cystic nodules in this primary care setting in Germany. The risks of malignancy for malignant, SFM, AUS/FLUS, and FN/SFN FNA cytologies are according to Bethesda recommendations.

摘要

背景

甲状腺结节细针抽吸细胞学（FNA）的报告结果主要来源于三级中心。然而，甲状腺结节 FNA 细胞学主要在初级保健机构进行，对于这些机构，FNA Bethesda 分类的分布及其各自的恶性率在很大程度上是未知的。因此，本研究调查了一个大型初级保健机构的 FNA 细胞学恶性率，以确定当前基于证据的甲状腺结节恶性风险分层策略在这种初级保健环境中的应用程度和适用性。

方法

在初级保健环境中，对一位细胞学医生（I.R.）在两年期间评估的 8380 例患者的 9460 例甲状腺结节 FNA 进行了回顾性分析。8380 例 FNA 细胞学检查由德国不同私人诊所的 64 名医生在初级保健机构进行。

结果

根据 Bethesda 系统对细胞学结果进行分类，非诊断性占 19%，囊/囊性结节占 21%，良性（包括甲状腺炎）占 48%，意义不明确的不典型性/滤泡性病变意义不明确（AUS/FLUS）占 6%，滤泡性肿瘤/疑似滤泡性肿瘤（FN/SFN）占 4%，疑似恶性（SFM）占 1%，恶性占 1%。进行手术或至少随访一年的患者比例以及观察到的恶性风险分别为 AUS/FLUS 为 22%/8%，FN/SFN 为 69%/17%，SFM 为 78%/86%，恶性为 71%/98%。对于 112 例细胞学可疑和恶性的 FNA，考虑到组织学为金标准，有 102 例真阳性和 10 例假阳性。