Department of Endocrinology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Department of Otolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Isr Med Assoc J. 2023 Feb;25(2):147-151.
Due to the high variability in malignancy rate among cytologically indeterminate thyroid nodules (Bethesda categories III-V), the American Thyroid Association recommends that each center define its own categorical cancer risk.
To assess cancer risk in patients with cytologically indeterminate thyroid nodules who were operated at our center.
In a retrospective study, we analyzed the pathology results of all the patients whose fine needle aspiration results showed Bethesda III-V cytology and who subsequently underwent total thyroidectomy or lobectomy from December 2013 to September 2017.
We analyzed 56 patients with indeterminate cytology on fine needle aspiration. Twenty-nine (52%) were defined as Bethesda III, 19 (34%) Bethesda IV, and 8 (14%) Bethesda V category. Malignancy rates were 38%, 58%, and 100% for Bethesda categories III, IV, and V, respectively. Most malignancies in Bethesda categories III and IV were follicular in origin (follicular thyroid carcinoma and follicular type papillary thyroid carcinoma), while 100% of the patients with Bethesda category V were diagnosed with classical papillary thyroid carcinoma. No correlation was found between sonographic and cytological criteria of nodules with Bethesda categories III and IV and rates of malignancy.
We found higher than expected rates of malignancy in indeterminate cytology. This finding reinforces the guidelines of the American Thyroid Association to establish local malignancy rates for thyroid nodules with indetermined cytology.
由于细胞学不确定的甲状腺结节（Bethesda 类别 III-V）的恶性肿瘤发生率变化较大，美国甲状腺协会建议每个中心都要定义自己的分类癌症风险。
评估在我们中心接受手术的细胞学不确定的甲状腺结节患者的癌症风险。
在一项回顾性研究中，我们分析了 2013 年 12 月至 2017 年 9 月期间所有细针抽吸细胞学结果为 Bethesda III-V 的患者的病理结果，这些患者随后接受了全甲状腺切除术或部分甲状腺切除术。
我们分析了 56 例细针抽吸细胞学不确定的患者。29 例（52%）被定义为 Bethesda III，19 例（34%）为 Bethesda IV，8 例（14%）为 Bethesda V 类。Bethesda 类别 III、IV 和 V 的恶性肿瘤发生率分别为 38%、58%和 100%。Bethesda 类别 III 和 IV 的大多数恶性肿瘤起源于滤泡（滤泡性甲状腺癌和滤泡型甲状腺乳头状癌），而 100%的 Bethesda 类别 V 患者被诊断为经典型甲状腺乳头状癌。在超声和细胞学标准方面，Bethesda 类别 III 和 IV 的结节与恶性肿瘤发生率之间没有相关性。
我们发现不确定细胞学的恶性肿瘤发生率高于预期。这一发现加强了美国甲状腺协会的指南，即建立不确定细胞学甲状腺结节的局部恶性肿瘤发生率。
