Department of Surgery, University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, OH. Electronic address: https://twitter.com/AaronDelman.
Department of Surgery, University of Cincinnati, OH; Cincinnati Research on Outcomes and Safety in Surgery (CROSS) Research Group, University of Cincinnati, OH.
Surgery. 2023 Mar;173(3):645-652. doi: 10.1016/j.surg.2022.06.049. Epub 2022 Oct 11.
The Bethesda System for Reporting Thyroid Cytopathology was formalized in 2007 to stratify cytologic specimens based on their risk of malignancy. Several studies have reported significant variations between their institutional rate of malignancy compared to the Bethesda System for Reporting Thyroid Cytopathology. The objective of this study was to determine the national rate of malignancy for Bethesda III, Bethesda IV, and Bethesda V thyroid nodules.
From 2016 to 2019, patients with preoperative thyroid cytopathology and pathology results in National Surgical Quality Improvement database were included. The rate of malignancy was compared to the median the Bethesda System for Reporting Thyroid Cytopathology 2017, and risk factors associated with malignancy were identified for Bethesda III, Bethesda IV, and Bethesda V specimens.
In total, 13,121 patients with preoperative cytopathology and postresection pathology were identified. The national rate of malignancy was significantly higher than the Bethesda System for Reporting Thyroid Cytopathology 2017 for Bethesda III (36.2% vs 12.0%, P < .01), Bethesda IV (36.7% vs 25.0%, P < .01), and Bethesda V (91.1% vs 52.5%, P < .01) specimens. Male sex was significantly associated with malignancy in Bethesda III, Bethesda IV, and Bethesda V nodules (Bethesda III, odds ratio: 1.20, [1.01-1.42]; Bethesda IV, odds ratio: 1.47, [1.27-1.71]; Bethesda V, odds ratio: 1.28, [1.03-1.58]). Younger age was associated with malignancy in Bethesda III patients under 55 (odds ratio: 1.23, [1.06-1.42]), Bethesda IV patients under 42 (odds ratio: 1.23, [1.06-1.43]), and Bethesda V patients aged less than 47 (odds ratio: 1.38, [1.15-1.67]).
This is the largest cohort study to describe the national rate of malignancy for Bethesda III, IV, and V specimens in the United States. These results reveal the national rate of malignancy is higher than the implied rate of malignancy reported to patients based on the Bethesda System for Reporting Thyroid Cytopathology. We recommend counseling patients regarding this increased rate of malignancy to set appropriate expectations after surgical intervention.
甲状腺细胞病理学报告贝塞斯达系统于 2007 年正式确立，旨在根据恶性肿瘤风险对细胞学标本进行分层。多项研究报告称，其机构的恶性肿瘤发生率与甲状腺细胞病理学报告贝塞斯达系统之间存在显著差异。本研究的目的是确定贝塞斯达 III、IV 和 V 型甲状腺结节的全国恶性肿瘤发生率。
2016 年至 2019 年，从国家外科质量改进数据库中纳入术前甲状腺细胞病理学和术后病理结果的患者。将恶性肿瘤发生率与 2017 年甲状腺细胞病理学报告贝塞斯达系统的中位数进行比较，并确定贝塞斯达 III、IV 和 V 型标本与恶性肿瘤相关的危险因素。
共纳入 13121 例术前细胞学和术后病理患者。全国恶性肿瘤发生率明显高于 2017 年甲状腺细胞病理学报告贝塞斯达系统，贝塞斯达 III（36.2%比 12.0%，P<0.01）、贝塞斯达 IV（36.7%比 25.0%，P<0.01）和贝塞斯达 V（91.1%比 52.5%，P<0.01）标本。男性在贝塞斯达 III、IV 和 V 结节中与恶性肿瘤显著相关（贝塞斯达 III，比值比：1.20，[1.01-1.42]；贝塞斯达 IV，比值比：1.47，[1.27-1.71]；贝塞斯达 V，比值比：1.28，[1.03-1.58]）。在贝塞斯达 III 年龄<55 岁（比值比：1.23，[1.06-1.42]）、贝塞斯达 IV 年龄<42 岁（比值比：1.23，[1.06-1.43]）和贝塞斯达 V 年龄<47 岁（比值比：1.38，[1.15-1.67]）的患者中，年龄较轻与恶性肿瘤相关。
这是迄今为止在美国描述贝塞斯达 III、IV 和 V 型标本全国恶性肿瘤发生率的最大队列研究。这些结果表明，全国恶性肿瘤发生率高于基于甲状腺细胞病理学报告贝塞斯达系统向患者报告的恶性肿瘤发生率。我们建议向患者咨询这一增加的恶性肿瘤发生率，以便在手术后对患者的预期进行适当的调整。
