Ha Su Min, Baek Jung Hwan, Na Dong Gyu, Jung Chan-Kwon, Suh Chong Hyun, Shong Young Kee, Sung Tae Yon, Song Dong Eun, Lee Jeong Hyun
Department of Radiology and Thyroid Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Radiology and Research Institute of Radiology, Seoul National University Hospital, Seoul, Korea.
Ultrasonography. 2021 Apr;40(2):228-236. doi: 10.14366/usg.19099. Epub 2020 May 19.
The diagnostic performance of thyroid biopsy is influenced by several factors, including differences in the Bethesda categorization for malignancy, the inclusion or exclusion of non-diagnostic results, the definition used for the final diagnosis, and the definition of an inconclusive diagnosis. The purpose of this study was to provide an understanding of the factors influencing the diagnostic performance of thyroid biopsy.
We collected data retrospectively between January and December 2013 from a cohort of 6,762 thyroid nodules from 6,493 consecutive patients who underwent biopsy. In total, 4,822 nodules from 4,553 patients were included. We calculated the biopsy sensitivity according to the inclusion of different Bethesda categories in the numerator and the exclusion of non-diagnostic results, as well as the diagnostic accuracy according to different definitions of a benign diagnosis. We obtained the conclusive and inconclusive diagnosis rates.
The sensitivity increased when more Bethesda categories were included in the numerator and when non-diagnostic results were excluded. When a benign thyroid nodule diagnosis was defined as benign findings on surgical resection, concordant benign results on at least two occasions, or an initial benign biopsy result and follow-up for more than 12 months, the accuracy was higher than when the diagnosis was based on surgical resection alone (91.1% vs. 68.7%). A higher conclusive diagnosis rate was obtained when Bethesda categories I and III were considered inconclusive than when Bethesda categories I, III and IV were considered inconclusive (78.3% vs. 72.8%, P<0.001).
Understanding the concepts presented herein is important in order to appropriately interpret the diagnostic performance of thyroid biopsy.
甲状腺活检的诊断性能受多种因素影响，包括恶性肿瘤的贝塞斯达分类差异、非诊断性结果的纳入或排除、最终诊断所用的定义以及不确定诊断的定义。本研究的目的是了解影响甲状腺活检诊断性能的因素。
我们回顾性收集了2013年1月至12月期间连续6493例接受活检的患者的6762个甲状腺结节的数据。总共纳入了4553例患者的4822个结节。我们根据分子中不同贝塞斯达分类的纳入情况以及非诊断性结果的排除情况计算活检敏感性，以及根据良性诊断的不同定义计算诊断准确性。我们获得了确定性和不确定性诊断率。
当分子中纳入更多贝塞斯达分类且排除非诊断性结果时，敏感性增加。当将良性甲状腺结节诊断定义为手术切除时的良性发现、至少两次一致的良性结果、或初始良性活检结果及超过12个月的随访时，准确性高于仅基于手术切除的诊断（91.1%对68.7%）。当将贝塞斯达分类I和III视为不确定时，获得的确定性诊断率高于将贝塞斯达分类I、III和IV视为不确定时（78.3%对72.8%，P<0.001）。
理解本文所呈现的概念对于正确解释甲状腺活检的诊断性能很重要。
