意大利甲状腺细胞学分类和报告共识：低危和高危不典型病变的恶性风险。系统评价和荟萃分析。
Italian consensus for the classification and reporting of thyroid cytology: the risk of malignancy between indeterminate lesions at low or high risk. A systematic review and meta-analysis.
机构信息
Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Section of Pathology, University Hospital Campus Bio Medico, Rome, Italy.
出版信息
Endocrine. 2019 Mar;63(3):430-438. doi: 10.1007/s12020-018-1825-8. Epub 2018 Dec 5.
BACKGROUND
Italian consensus for the classification and reporting of thyroid cytology has proposed to discriminate the cancer prevalence of high (Tir 3B) vs. low (Tir 3A) risk indeterminate nodules. To obtain more robust evidence on this topic, we performed a meta-analysis of the Odds Ratio (OR) of malignancy of Tir 3B vs. Tir 3A nodules.
METHODS
A comprehensive literature exploration of online databases was conducted until May 2018. Original articles reporting histology of nodules cytologically classified as Tir 3A and Tir 3B were eligible. Pooled cancer prevalence in Tir 3A and Tir 3B, and OR of Tir 3B vs. Tir 3A were calculated.
RESULTS
The search revealed 95 articles, and 10 were included for the meta-analysis. Overall, 1168 indeterminate lesions were reported (441 Tir 3A and 727 Tir 3B), of which 391 were cancers. The pooled cancer prevalence was 17% in Tir 3A and 47% in Tir 3B. The OR of Tir 3B vs. Tir 3A was 4.24 (95% CI 2.75 to 6.53) with mild heterogeneity and without publication bias. When we considered non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as non-malignant, cancer rate was lower, and OR of Tir 3B against Tir 3A was 2.93 (95% CI 1.60 to 5.37), with no heterogeneity but with publication bias.
CONCLUSIONS
The Italian system for thyroid cytology is reliable to assess indeterminate lesions at low and high risk, being Tir 3B associated with a cancer risk significantly higher than Tir 3A, also when considering NIFTP as non-malignant entity.
背景
意大利的甲状腺细胞学分类和报告共识建议区分高（Tir 3B）和低（Tir 3A）风险的不确定结节的癌症患病率。为了获得这个主题更可靠的证据，我们对 Tir 3B 与 Tir 3A 结节的恶性肿瘤比值比（OR）进行了荟萃分析。
方法
对在线数据库进行了全面的文献检索，直到 2018 年 5 月。有资格入选的原始文章报告了细胞学分类为 Tir 3A 和 Tir 3B 的结节的组织学结果。计算了 Tir 3A 和 Tir 3B 中的癌症总患病率和 Tir 3B 与 Tir 3A 的 OR。
结果
搜索结果显示有 95 篇文章，其中 10 篇被纳入荟萃分析。总的来说，报告了 1168 个不确定病变（441 个 Tir 3A 和 727 个 Tir 3B），其中 391 个为癌症。Tir 3A 的癌症总患病率为 17%，Tir 3B 的为 47%。Tir 3B 与 Tir 3A 的 OR 为 4.24（95%CI 2.75 至 6.53），存在轻度异质性且无发表偏倚。当我们将非浸润性滤泡性甲状腺肿瘤伴乳头状核特征（NIFTP）视为非恶性肿瘤时，癌症发生率较低，Tir 3B 与 Tir 3A 的 OR 为 2.93（95%CI 1.60 至 5.37），无异质性但存在发表偏倚。
结论
意大利的甲状腺细胞学分类系统可靠地评估了低风险和高风险的不确定病变，Tir 3B 与 Tir 3A 相比，癌症风险显著增加，当将 NIFTP 视为非恶性实体时也是如此。
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