Słowińska-Klencka Dorota, Wysocka-Konieczna Kamila, Klencki Mariusz, Popowicz Bożena
Department of Morphometry of Endocrine Glands, Chair of Endocrinology, Medical University of Lodz, Pomorska Str 251, 92-213 Łódź, Poland.
J Clin Med. 2020 Oct 24;9(11):3410. doi: 10.3390/jcm9113410.
The aim of this study was to compare the diagnostic effectiveness of EU-TIRADS in two groups of nodules with equivocal cytology (categories III-V of Bethesda system), with and without Hürthle cells (HC and non-HC). The study included 162 HC and 378 non-HC nodules with determined histopathological diagnosis (17.9% and 15.6% cancers). In both groups calculated and expected risk of malignancy (RoM) for high, intermediate and benign risk categories of EU-TIRADS were concordant. RoM for low risk category was higher than expected in both groups, but especially in HC (HC: 13.9%, non-HC: 7.0%, expected: 2-4%). The majority of cancers in HC of that category were follicular thyroid carcinomas (FTC) and Hürthle cell thyroid carcinoma (HTC) (60.0% vs. non-HC: 16.7%). The diagnostic efficacy of EU-TIRADS was lower in HC (the area under the receiver operating characteristics curve (AUC): 0.621, sensitivity (SEN): 44.8%, specificity (SPC): 78.9% for high risk threshold) than in non-HC (AUC: 0.711, SEN: 61.0%, SPC: 77.7%). AUC was the highest for category V (AUC > 0.8, both groups) and the lowest for category IV (inefficient, both group). If intermediate risk category was interpreted as an indication for surgery, 25% of cancers from category III and 21.4% from category IV would not be treated in the HC group (0.0% and 7.4% from non-HC group, respectively). EU-TIRADS does not aid making clinical decisions in patients with cytologically equivocal HC nodules, particularly those classified into category IV of Bethesda System for Reporting Thyroid Cytopathology (BSRTC).
本研究的目的是比较欧盟甲状腺影像报告和数据系统（EU-TIRADS）在两组细胞病理学结果不明确（贝塞斯达系统III-V类）的结节中的诊断效能，这两组结节分别含有和不含有许特莱细胞（HC和非HC）。该研究纳入了162个含HC结节和378个不含HC结节，并确定了其组织病理学诊断结果（癌症发生率分别为17.9%和15.6%）。在两组中，EU-TIRADS高、中、低风险类别的计算出的和预期的恶性风险（RoM）是一致的。低风险类别的RoM在两组中均高于预期，但在含HC结节组中尤为明显（含HC结节组：13.9%，非含HC结节组：7.0%，预期：2-4%）。该类别含HC结节中的大多数癌症为甲状腺滤泡癌（FTC）和许特莱细胞甲状腺癌（HTC）（60.0%，而非含HC结节组为16.7%）。EU-TIRADS在含HC结节组中的诊断效能低于非含HC结节组（高风险阈值下的受试者工作特征曲线下面积（AUC）：0.621，灵敏度（SEN）：44.8%，特异度（SPC）：78.9%）（AUC：0.711，SEN：61.0%，SPC：77.7%）。V类的AUC最高（两组均AUC>0.8），IV类的AUC最低（两组均无诊断效能）。如果将中风险类别解释为手术指征，在含HC结节组中，III类中的25%癌症和IV类中的21.4%癌症将得不到治疗（非含HC结节组分别为0.0%和7.4%）。EU-TIRADS无助于对细胞病理学结果不明确的含HC结节患者做出临床决策，尤其是那些被归类为甲状腺细胞病理学报告贝塞斯达系统（BSRTC）IV类的患者。
