甲状腺影像学报告和数据系统实施后甲状腺结节细胞学检查率的变化。
Changes in thyroid nodule cytology rates after institutional implementation of the Thyroid Imaging Reporting and Data System.
机构信息
Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
Department of Pathology, University of Pittsburgh, Pittsburgh, PA.
出版信息
Surgery. 2023 Jan;173(1):232-238. doi: 10.1016/j.surg.2022.06.061. Epub 2022 Oct 14.
BACKGROUND
The American College of Radiology Thyroid Imaging Reporting and Data System for ultrasound classification of malignancy risk was developed to better triage thyroid nodules for fine-needle aspiration biopsy. To examine further, we compared thyroid cytologic classification rates in nodules before and after institutional Thyroid Imaging Reporting and Data System implementation.
METHODS
Cytology diagnoses by Bethesda criteria (categories I-VI) from January 2014 to October 2021 were retrieved; observed changes in yearly category frequency were analyzed by linear regression; and pooled cohorts of pre- (2014-2018) and post-Thyroid Imaging Reporting and Data System (2019-2021) cytology call rates were compared.
RESULTS
Overall, 7,413 cytologic specimens were included (range/year 715-1,444). From 2014 to 2021, the proportion of benign (Bethesda category II) diagnosis per year declined stepwise from 49.7% to 19.4%, and atypia of undetermined significance/follicular lesion of undetermined significance (Bethesda category III) increased sequentially from 21.3% to 51.5%. Between 2014 and 2021, Bethesda category III diagnosis increased on average by 4.8% per year (95% confidence internal, 3.29-5.54; P < .001) and Bethesda category II results decreased on average by 4.4% per year (95% confidence interval, 6.29-3.42; P < .001). When comparing pre- and post-Thyroid Imaging Reporting and Data System, the proportion of Bethesda category II cytology results decreased (43.1% vs 21%; P = .001) while Bethesda category III (28.3% vs 47.7%; P = .002) and Bethesda category V (1.1% vs 1.7%; P = .015) results increased.
CONCLUSION
After implementation of American College of Radiology Thyroid Imaging Reporting and Data System ultrasound criteria, we observed a 2.5-fold decline in the rate of benign cytology and an increase in the proportion of atypia of undetermined significance/follicular lesion of undetermined significance results.
背景
美国放射学院甲状腺成像报告和数据系统（ACR TI-RADS）对恶性风险的超声分类进行了研究，以更好地对甲状腺结节进行细针抽吸活检。为了进一步研究，我们比较了该系统实施前后甲状腺细胞学分类率的变化。
方法
回顾 2014 年 1 月至 2021 年 10 月期间的 Bethesda 标准（类别 I-VI）甲状腺细胞学诊断；通过线性回归分析每年类别的频率变化；并比较了 ACR TI-RADS 实施前（2014-2018 年）和实施后（2019-2021 年）的甲状腺细胞学诊断率的合并队列。
结果
共纳入 7413 例细胞学标本（范围/年 715-1444）。2014 年至 2021 年，良性（Bethesda 类别 II）诊断的比例逐年递减，从 49.7%降至 19.4%，而意义不明确的不典型性/滤泡性病变不明确（Bethesda 类别 III）的比例则从 21.3%递增至 51.5%。2014 年至 2021 年间，Bethesda 类别 III 诊断平均每年增加 4.8%（95%置信区间，3.29-5.54；P<.001），而 Bethesda 类别 II 结果平均每年减少 4.4%（95%置信区间，6.29-3.42；P<.001）。比较 ACR TI-RADS 实施前后，Bethesda 类别 II 细胞学结果的比例降低（43.1%比 21%；P=.001），而 Bethesda 类别 III（28.3%比 47.7%；P=.002）和 Bethesda 类别 V（1.1%比 1.7%；P=.015）的结果增加。
结论
实施美国放射学院甲状腺成像报告和数据系统超声标准后，良性细胞学的比例下降了 2.5 倍，意义不明确的不典型性/滤泡性病变不明确的比例增加。
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