Turkdogan Sena, Pusztaszeri Marc, Forest Veronique-Isabelle, Hier Michael P, Payne Richard J
Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
Department of Pathology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
Cancers (Basel). 2020 Sep 9;12(9):2563. doi: 10.3390/cancers12092563.
The Bethesda classification system for thyroid fine needle aspirate (FNA) is used to predict the risk of malignancy and to guide the management of thyroid nodules. We postulated that thyroid malignancies characterized as Bethesda III on FNA have more aggressive features than those classified as Bethesda IV. A retrospective chart review was performed to identify those who underwent thyroid surgery at a single tertiary hospital setting between 2015 and 2020. Associations between Bethesda category, molecular genetic test results, and histopathologic findings were examined. Out of 628 surgeries that were performed, 199 (54.2%) Bethesda III nodules and 216 (82.8%) Bethesda IV nodules were malignant. Of those that were malignant, 37 (18.6%) and 22 (10.2%) Bethesda III and Bethesda IV nodules showed aggressive features, respectively ( value = 0.014). There was a proportionally increased number of aggressive features in extra-thyroidal extension, lymph nodes metastasis, and all aggressive subtypes of papillary thyroid cancer in the Bethesda III category. Although Bethesda IV nodules are much more likely to be malignant ( value = 0.002), our study suggests that Bethesda III nodules that are resected are more likely to have aggressive features than Bethesda IV nodules, with a statistically significant increase in the solid variant of papillary thyroid cancer and lymph node metastasis.
甲状腺细针穿刺抽吸（FNA）的贝塞斯达分类系统用于预测恶性风险并指导甲状腺结节的管理。我们推测，FNA分类为贝塞斯达III类的甲状腺恶性肿瘤比分类为贝塞斯达IV类的具有更具侵袭性的特征。进行了一项回顾性病历审查，以确定2015年至2020年期间在一家三级医院接受甲状腺手术的患者。研究了贝塞斯达分类、分子基因检测结果和组织病理学发现之间的关联。在进行的628例手术中，199例（54.2%）贝塞斯达III类结节和216例（82.8%）贝塞斯达IV类结节为恶性。在这些恶性结节中，分别有37例（18.6%）和22例（10.2%）贝塞斯达III类和贝塞斯达IV类结节表现出侵袭性特征（P值=0.014）。在贝塞斯达III类中，甲状腺外侵犯、淋巴结转移以及甲状腺乳头状癌所有侵袭性亚型中的侵袭性特征数量成比例增加。尽管贝塞斯达IV类结节更有可能是恶性的（P值=0.002），但我们的研究表明，切除的贝塞斯达III类结节比贝塞斯达IV类结节更有可能具有侵袭性特征，甲状腺乳头状癌实性变体和淋巴结转移在统计学上有显著增加。
