基于 Bethesda 分类的细针抽吸细胞学检查在儿科甲状腺结节中的诊断价值。
Diagnostic utility of fine needle aspiration cytology in pediatric thyroid nodules based on Bethesda Classification.
机构信息
Division of Otolaryngology, Department of Surgery, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA.
Division of Endocrinology, Department of Pediatrics, University of California San Diego, Rady Children's Hospital in San Diego, San Diego, CA, USA.
出版信息
J Pediatr Endocrinol Metab. 2021 Feb 24;34(4):449-455. doi: 10.1515/jpem-2020-0645. Print 2021 Apr 27.
OBJECTIVES
The Bethesda system for reporting cytopathology (TBSRTC) has been widely adopted in the management of thyroid nodules. Based on the limited pediatric data available, the implied malignancy risk for each of the categories may be significantly different in pediatrics vs. adults, especially in the indeterminate categories (Bethesda Class III or IV). We report the diagnostic utility of fine needle aspiration (FNA) biopsy at our institution based on the Bethesda system and the risk of malignancy in each category.
METHODS
We retrospectively reviewed all patients who underwent a thyroid FNA at our tertiary pediatric hospital from 12/1/2002 to 11/30/2018. FNA results were classified according to TBSRTC. Patient demographics, cytology, histopathology, radiological and clinical follow-ups were examined.
RESULTS
A total of 171 patients were included with 203 cytological samples. Average age at initial FNA was 14.7 years (range 6.9-18.6 years). The numbers of nodules reported for Bethesda categories I-VI were 29, 106, 22, 14, 6 and 26, respectively, and the rate of malignancy was: 13.8, 4.7, 22.7, 35.7, 83.3 and 100%, respectively. Use of ultrasound guidance reduced the non-diagnostic rate from 38.1 to 11.5%. Introduction of on-site adequacy testing further reduced the non-diagnostic rate to 6.5% since 2014.
CONCLUSIONS
The risk of malignancy for thyroid nodules in this pediatric cohort is higher than reported in adults. However, rates described here are much closer to adult ranges than previously published pediatric cohorts. The addition of adequacy testing improved the non-diagnostic rate of FNA procedures performed with ultrasound guidance.
目的
甲状腺结节的管理中广泛采用了巴氏报告细胞学系统（TBSRTC）。基于现有的有限儿科数据，每个类别在儿科与成人中的恶性肿瘤风险可能存在显著差异，尤其是在不确定类别（巴氏 III 类或 IV 类）中。我们报告了基于巴氏系统和各分类恶性肿瘤风险的我院细针抽吸活检（FNA）的诊断效能。
方法
我们回顾性分析了 2002 年 12 月 1 日至 2018 年 11 月 30 日期间在我院接受甲状腺 FNA 的所有患者。FNA 结果根据 TBSRTC 进行分类。检查了患者的人口统计学资料、细胞学、组织病理学、影像学和临床随访结果。
结果
共纳入 171 例患者，共进行了 203 次细胞学检查。初次 FNA 的平均年龄为 14.7 岁（范围 6.9-18.6 岁）。巴氏分类 I-VI 报告的结节数量分别为 29、106、22、14、6 和 26，恶性肿瘤的发生率分别为 13.8%、4.7%、22.7%、35.7%、83.3%和 100%。使用超声引导将非诊断率从 38.1%降至 11.5%。自 2014 年以来，引入现场评估检测进一步将非诊断率降低至 6.5%。
结论
本儿科队列中甲状腺结节的恶性肿瘤风险高于成人报道的风险。然而，这里描述的发生率比以前发表的儿科队列更接近成人范围。在超声引导下进行的 FNA 操作中，添加适当的检测可提高非诊断率。
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