Centre de Biologie et Pathologie Sud, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
Biochemistry and Molecular Biology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
Cytopathology. 2021 Jan;32(1):37-44. doi: 10.1111/cyt.12904. Epub 2020 Oct 12.
The cytological diagnosis of follicular-patterned thyroid lesions is challenging, especially since the World Health Organisation classification has recognised non-invasive follicular thyroid neoplasm with papillary-like features. These entities are often classified as indeterminate on cytology. Molecular testing has been proposed to help classify indeterminate nodules. RAS and K601E BRAF mutations are mostly encountered in follicular-patterned lesions, but their diagnostic value is not well established. Nuclear scores have also been proposed to help classify indeterminate lesions.
To investigate the correlation between cytological features and histology and to assess nuclear scores in a series of indeterminate RAS or BRAF K601E positive thyroid nodules.
The cytological parameters of 69 indeterminate RAS or BRAF K601E-positive thyroid nodules were evaluated. The Strickland and Maletta scores and a new nuclear score were assessed. Diagnosis of malignant, benign or indolent neoplasms was confirmed in each case by histology. Malignant and indolent nodules were considered surgical nodules, and adenomas non-surgical nodule.
Surgical nodules were associated with the presence of ground glass nuclei (P = .001), grooves (P < .001) or irregular nuclear membranes (P = .01) on cytology. Nuclear scores were more often ≥2 in surgical nodules compared to benign ones (P < .001), with high sensitivity, but a low negative predictive value.
Analysis of nuclear features is useful to distinguish non-surgical from surgical nodules in indeterminate FNAs. Although nuclear scores are not ideal rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they seem useful to screen non-molecular tested or non-mutated indeterminate FNAs. This work shows that meticulous analysis of nuclear features on cytological specimens can be useful to distinguish non-surgical nodules (adenoma) from surgical nodules in indeterminate FNAs. Although nuclear scores are not rule-out tests for indeterminate RAS or BRAF K601E positive nodules, they are useful in screening non-molecular tested or non-mutated indeterminate FNAs for surgery.
滤泡性甲状腺病变的细胞学诊断具有挑战性，特别是世界卫生组织（World Health Organisation）分类已经认识到具有乳头状特征的非浸润性滤泡性甲状腺肿瘤。这些实体通常在细胞学上被归类为不确定。分子检测已被提议用于帮助分类不确定的结节。RAS 和 K601E BRAF 突变主要见于滤泡性病变，但它们的诊断价值尚未得到充分确立。核评分也被提议用于帮助分类不确定的病变。
研究一系列不确定的 RAS 或 BRAF K601E 阳性甲状腺结节中细胞学特征与组织学的相关性，并评估核评分。
评估了 69 个不确定的 RAS 或 BRAF K601E 阳性甲状腺结节的细胞学参数。评估了 Strickland 和 Maletta 评分以及新的核评分。通过组织学确认每个病例的恶性、良性或惰性肿瘤的诊断。恶性和惰性结节被认为是手术性结节，腺瘤是非手术性结节。
细胞学上存在毛玻璃核（P =.001）、沟（P <.001）或不规则核膜（P =.01）与手术性结节相关。与良性结节相比，手术性结节的核评分更常≥2（P <.001），具有较高的敏感性，但阴性预测值较低。
在不确定的细针抽吸活检（FNAs）中，分析核特征有助于区分非手术性和手术性结节。虽然核评分不是不确定的 RAS 或 BRAF K601E 阳性结节的理想排除试验，但它们似乎有助于筛选非分子检测或非突变的不确定 FNAs。这项工作表明，在不确定的 FNAs 中，对细胞学标本核特征的细致分析有助于区分非手术性结节（腺瘤）和手术性结节。虽然核评分不是不确定的 RAS 或 BRAF K601E 阳性结节的排除试验，但它们在筛选非分子检测或非突变的不确定 FNAs 以进行手术方面是有用的。
