Department of Pathology, University of Chicago, Chicago, IL.
Centegra Health System, McHenry, IL.
Am J Clin Pathol. 2019 Jan 1;151(1):86-94. doi: 10.1093/ajcp/aqy109.
Bethesda category III (atypia of undetermined significance/follicular lesion of undetermined significance) includes sparsely cellular specimens with nuclear atypia (3N) and/or architectural atypia (3A). This study investigates whether the two types of atypia have different rates of malignancy (ROMs).
Cytologic and histologic diagnoses of resected thyroid nodules were recorded. ROM was calculated for all Bethesda categories and for 3N and 3A subcategories. Possible noninvasive follicular thyroid neoplasms with papillary-like nuclear features were reviewed and removed from malignancies, and ROM was recalculated.
A total of 1,396 nodules were included. ROM of 3N (33.3%-26.0%) was higher than 3A (7.7%-5.0%) (P < .0001) and was similar to suspicious for follicular neoplasm (25.0%-20.3%) (P = .3). ROM of 3A approached benign (2.4%-1.5%) (P = .02).
Strong consideration should be given to separating 3N (nuclear atypia with higher risk for papillary thyroid carcinoma) from 3A (architectural atypia with higher chance of being benign) to convey different ROMs.
贝塞斯达分类 III 级（意义不明确的不典型/意义不明确的滤泡性病变）包括核异型性（3N）和/或结构异型性（3A）稀疏的细胞标本。本研究旨在探讨这两种异型性的恶性程度（ROM）是否不同。
记录切除甲状腺结节的细胞学和组织学诊断。计算所有贝塞斯达分类以及 3N 和 3A 亚类的 ROM。对具有乳头状核特征的可能无侵袭性滤泡性甲状腺肿瘤进行了回顾，并从恶性肿瘤中去除，重新计算了 ROM。
共纳入 1396 个结节。3N（33.3%-26.0%）的 ROM 高于 3A（7.7%-5.0%）（P<0.0001），与滤泡性肿瘤可疑（25.0%-20.3%）相似（P=0.3）。3A 的 ROM 接近良性（2.4%-1.5%）（P=0.02）。
强烈建议将 3N（具有更高的甲状腺乳头状癌风险的核异型性）与 3A（具有更高良性可能性的结构异型性）分开，以传达不同的 ROM。
