Guo H Q, Zhao H, Cao J, Zhao L L, Sun Y, Wang C, Zhang Z H
Department of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Mar 7;55(3):258-262. doi: 10.3760/cma.j.issn.1673-0860.2020.03.013.
To analyze the data of the Bethesda system for reporting thyroid cytopathology applied in a comprehensive cancer center and to evaluate the diagnostic ability of fine needle aspiration (FNA). We retrospectively reviewed the medical records of 5 729 cases applying this reporting system at Cancer Hospital, Chinese Academy of Medical Sciences. The series were from 5 011 patients including 1 174 men and 3 837 women, and their median age was 45 years (range, 7-88 years). FNA results were correlated with final histological diagnosis after surgery and the accuracy of FNA diagnosis and the malignancy rates for each of categories were also analyzed. Among 5 729 thyroid aspirates, aside from 456 (8.0%) cases with nondiagnostic or unsatisfactory (ND/UNS) outcomes, 1 055 (18.4%) cases were benign, 409 (7.1%) cases showed atypical of undetermined significance or follicular lesions with undetermined significance (AUS/FLUS), 80 (1.4%) cases were follicular neoplasm or suspicious for follicular neoplasm (FN/SFN), 982 (17.1%) cases were suspicious for malignancy (SUS), and 2 747 cases were malignant (47.9%). Of 5 729 cases, 3 239 had received thyroidectomies after FNA, 95.99% of them were proven histologically to be malignant, with following malignancy rates in individual FNA categories: ND/UNS 75.00%; benign 40.91%; AUS/FLUS 77.67%; FN/SFN 41.67%; SUS 96.86%; and malignant 99.96%. FNA predicted malignancy with sensitivity, specificity, accuracy, positive predictive value and negative predictive values of 98.8%, 60.5%, 97.7%, 98.9% and 59.1%, respectively. The data of the Bethesda reporting system indicates high proportion of malignant diagnosis and high risk of malignancy at all FNA diagnostic categories. FNA offers high diagnostic accuracy and positive predictive value for the diagnosis of thyroid diseases.
分析在一家综合癌症中心应用的甲状腺细胞病理学贝塞斯达报告系统的数据，并评估细针穿刺（FNA）的诊断能力。我们回顾性分析了中国医学科学院肿瘤医院应用该报告系统的5729例病例的病历。该系列病例来自5011名患者，其中男性1174名，女性3837名，他们的年龄中位数为45岁（范围7 - 88岁）。FNA结果与术后最终组织学诊断相关，并分析了FNA诊断的准确性以及各分类的恶性率。在5729例甲状腺穿刺样本中，除456例（8.0%）结果为无法诊断或不满意（ND/UNS）外，1055例（18.4%）为良性，409例（7.1%）显示意义不明确的非典型性或意义不明确的滤泡性病变（AUS/FLUS），80例（1.4%）为滤泡性肿瘤或可疑滤泡性肿瘤（FN/SFN），982例（17.1%）为可疑恶性（SUS），2747例为恶性（47.9%）。在5729例病例中，3239例在FNA后接受了甲状腺切除术，其中95.99%经组织学证实为恶性，各FNA分类的恶性率如下：ND/UNS为75.00%；良性为40.91%；AUS/FLUS为77.67%；FN/SFN为41.67%；SUS为96.86%；恶性为99.96%。FNA预测恶性的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为98.8%、60.5%、97.7%、98.9%和59.1%。贝塞斯达报告系统的数据表明所有FNA诊断分类中恶性诊断比例高且恶性风险高。FNA对甲状腺疾病的诊断具有较高的诊断准确性和阳性预测值。
