Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland.
Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Eur J Endocrinol. 2019 Oct;181(4):389-396. doi: 10.1530/EJE-19-0223.
The second version of The Bethesda System for Reporting Thyroid Cytopathology endorsed the introduction of non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as a distinct entity with low malignant potential into clinical practice. Consequently, the risk of malignancy (ROM) of cytological diagnoses has changed, but the magnitude of the change remains uncertain. The present systematic review was undertaken to obtain more robust information about the true impact of NIFTP on the ROM among patients undergoing surgery following a fine-needle aspiration cytology (FNAC) diagnosis of suspicious for malignancy (Bethesda V) or malignant (Bethesda VI). As they are managed surgically, these two diagnostic categories are the primary entities that are clinically impacted by the advent of NIFTP.
Systematic review and meta-analysis.
A comprehensive literature search of online databases was performed in November 2018. The search was conducted looking for data of histologically proven NIFTP with preoperative FNAC.
One-hundred fifty-seven articles were identified and nine were included in the study. Overall, there were 13,752 thyroidectomies with a cancer prevalence of 45.7%. When NIFTP was considered non-malignant, the pooled risk difference for ROM was 5.5%. Applying meta-analysis, the pooled prevalence of NIFTP among nodules with FNAC of Bethesda V or Bethesda VI was 14 and 3%, respectively.
This meta-analysis shows that the inclusion of NIFTP leads to a reduction in the ROM for the Bethesda V and Bethesda VI FNAC diagnostic categories by 14 and 3%, respectively. Clinicians should be aware of these data to avoid overtreatment.
第二版《甲状腺细胞病理学报告贝塞斯达系统》（Bethesda System for Reporting Thyroid Cytopathology）支持将具有乳头状核特征的非侵袭性滤泡性甲状腺肿瘤（NIFTP）作为一种具有低恶性潜能的独特实体引入临床实践。因此，细胞学诊断的恶性风险（ROM）发生了变化，但变化的幅度仍不确定。本系统评价旨在获得更可靠的信息，了解 NIFTP 对细针抽吸细胞学（FNAC）诊断为可疑恶性（Bethesda V）或恶性（Bethesda VI）的患者手术后 ROM 的真正影响。由于这些患者需要手术治疗，因此这两种诊断类别是受 NIFTP 出现影响的主要实体。
系统评价和荟萃分析。
2018 年 11 月对在线数据库进行了全面的文献检索。搜索时寻找了术前 FNAC 证实为 NIFTP 的组织学数据。
共确定了 157 篇文章，其中 9 篇被纳入研究。共有 13752 例甲状腺切除术，癌症患病率为 45.7%。当 NIFTP 被认为是非恶性时，ROM 的风险差异为 5.5%。应用荟萃分析，FNAC 为 Bethesda V 或 Bethesda VI 的结节中 NIFTP 的 pooled 患病率分别为 14%和 3%。
这项荟萃分析表明，纳入 NIFTP 可使 Bethesda V 和 Bethesda VI FNAC 诊断类别中的 ROM 分别降低 14%和 3%。临床医生应了解这些数据，以避免过度治疗。
