Department of Pathology, Faculty of Medicine, Kocaeli University, 41380, Kocaeli, Turkey.
BMC Endocr Disord. 2020 Apr 15;20(1):48. doi: 10.1186/s12902-020-0530-9.
Fine-needle aspiration cytology (FNAC) has become a well-established modality in the diagnosis, staging and follow-up of thyroid nodules. FNAC outcomes are routinely classified using the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), facilitating appropriate clinical management. Bethesda categories III and IV encompass varying risks of malignancy. This retrospective study established a possible association between these cytological categories and malignancy rates in patients treated at a single institution.
Over a 6-year period, 11,627 FNAC procedures were performed on thyroid nodules. Of these, 814 (59.63%) patients were submitted to thyroidectomy. The nodules of 108 patients were classified as Bethesda category III and 47 patients as Bethesda category IV. Patient data were reviewed to establish a correlation between the FNAC results and the final histopathological analyses.
The rates of malignancy among patients who underwent surgery were 25% for category III and 27.6% for category IV, with no significant differences between categories (p = 0.67). The pathological parameters of malignant nodules, namely tumour type, size, encapsulation, invasion into the thyroid capsule, extrathyroidal extension and lymphovascular invasion did not significantly differ between the groups (p > 0.05).
This paper provides a more precise correlation of malignancy rates with thyroid nodules classified as Bethesda categories III and IV, as our findings are comparable to the literature, giving malignancy rates ranging from 10 to 30% for category III and 25-40% for category IV. Use of the BSRTC is heterogeneous across institutions, and there is some degree of subjectivity in the distinction between categories III and IV; therefore, it is crucial to estimate the rates of malignancy at each institution. Molecular assays are of increasing importance in determining the need for surgical intervention for thyroid lesions. Gene expression assays using FNAC material may demonstrate a high predictive value for cytologically indeterminate thyroid nodules diagnosed as Bethesda classes III and IV.
细针穿刺细胞学检查（FNAC）已成为诊断、分期和随访甲状腺结节的成熟手段。FNAC 结果通常使用甲状腺细胞病理学报告的 Bethesda 系统（BSRTC）进行分类，以方便进行适当的临床管理。Bethesda 分类系统 III 和 IV 涵盖了不同的恶性肿瘤风险。本回顾性研究旨在确定在单一机构治疗的患者中，这些细胞学分类与恶性肿瘤发生率之间可能存在的关联。
在 6 年期间，对 11627 例甲状腺结节进行了 FNAC 检查。其中 814 例（59.63%）患者接受了甲状腺切除术。108 例患者的结节被分类为 Bethesda 分类系统 III，47 例患者的结节被分类为 Bethesda 分类系统 IV。回顾患者数据，以确定 FNAC 结果与最终组织病理学分析之间的相关性。
接受手术的患者中，恶性肿瘤的发生率在分类系统 III 为 25%，在分类系统 IV 为 27.6%，两者之间无显著差异（p=0.67）。恶性结节的病理参数，即肿瘤类型、大小、包膜、甲状腺包膜侵犯、甲状腺外侵犯和血管侵犯，在两组之间无显著差异（p>0.05）。
本文提供了更精确的相关性，即与被分类为 Bethesda 分类系统 III 和 IV 的甲状腺结节相比，恶性肿瘤的发生率，因为我们的发现与文献相符，为分类系统 III 提供了 10-30%的恶性肿瘤发生率，为分类系统 IV 提供了 25-40%的恶性肿瘤发生率。BSRTC 在不同机构的使用存在异质性，并且在分类系统 III 和 IV 之间存在一定程度的主观性；因此，估计每个机构的恶性肿瘤发生率至关重要。分子检测在确定需要对细胞学不确定的甲状腺结节进行手术干预方面具有越来越重要的意义。使用 FNAC 材料进行基因表达检测可能对诊断为 Bethesda 分类系统 III 和 IV 的细胞学不确定甲状腺结节具有很高的预测价值。
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