The Thyroid Center, Columbia University Irving Medical Center, New York, New York, USA.
Republican Research Center for Radiation Medicine and Human Ecology, Gomel, Belarus.
Acta Cytol. 2024;68(1):34-44. doi: 10.1159/000536387. Epub 2024 Jan 19.
The Chernobyl nuclear accident exposed residents of contaminated territories to substantial quantities of radioiodines and was followed by an increase in thyroid cancer, primarily papillary thyroid cancer (PTC), among exposed children and adolescents. Although thyroid biopsy is an essential component of screening programs following accidental exposure to radioiodines, it is unknown whether the predictive value of biopsy is affected by different levels of environmental exposure.
A cohort of 11,732 Belarusians aged ≤18 years at the time of the Chernobyl accident with individual thyroid radiation dose estimates was screened at least once 11-22 years later. Paired cytologic conclusions and histopathologic diagnoses were possible for 258 thyroid nodules from 238 cohort members. Cytologic conclusions were divided into five reporting categories, with all follicular lesion aspirates combined into a single indeterminate category. Standard performance indicators, risk of malignancy (ROM), and odds ratios for a correct cytologic conclusion were calculated, both overall and according to quintile of thyroid radiation dose.
The arithmetic mean thyroid dose estimate for the study group was 1.73 Gy (range: 0.00-23.64 Gy). The final histopathologic diagnosis was cancer for 136 of 258 biopsies (52.7%; 135 papillary and 1 follicular). The overall ROM was 96.7% for cytologies definite for PTC, 83.7% for suspicious for PTC, 33.0% for indeterminate, 8.1% for benign, and 31.0% for non-diagnostic. The ROM showed little change according to level of radiation exposure. Overall, there was no association between thyroid radiation dose and the odds ratio for a correct cytologic conclusion (p = 0.24). When analyzed according to dose quintile, the odds ratio for a correct conclusion increased two-fold at 0.10-0.29 Gy compared to a dose of 0.00-0.09 Gy and decreased at doses of 0.3-24 Gy (p value for linear trend = 0.99).
At radiation doses received by a cohort of young Belarusians exposed to radioiodines by the Chernobyl accident, the predictive value of thyroid biopsy for diagnosing PTC was not significantly affected by level of radiation exposure.
切尔诺贝利核事故使受污染地区的居民暴露于大量放射性碘，并随后导致受照射的儿童和青少年中甲状腺癌（主要是乳头状甲状腺癌，PTC）的发病率增加。尽管甲状腺活检是放射性碘意外暴露后筛查计划的重要组成部分，但尚不清楚活检的预测值是否受到不同环境暴露水平的影响。
在切尔诺贝利事故时年龄≤18 岁的 11732 名白俄罗斯人中，对其中的一部分进行了筛查，至少在事故发生后 11-22 年进行了一次筛查。在 238 名队列成员中，有 258 个甲状腺结节的细胞学结论和组织病理学诊断是可以进行配对的。将所有滤泡性病变的抽吸物合并为一个不确定的分类，将细胞学结论分为五个报告类别。计算了总体和按甲状腺辐射剂量五分位数的标准性能指标、恶性肿瘤风险（ROM）和正确细胞学结论的比值比。
研究组的算术平均甲状腺剂量估计值为 1.73Gy（范围：0.00-23.64Gy）。258 个活检标本的最终组织病理学诊断为癌症的有 136 个（52.7%；135 个乳头状癌和 1 个滤泡状癌）。对于细胞学明确的 PTC，总体 ROM 为 96.7%，可疑 PTC 为 83.7%，不确定为 33.0%，良性为 8.1%，无法诊断为 31.0%。根据辐射暴露水平，ROM 变化不大。总体而言，甲状腺辐射剂量与正确细胞学结论的比值比之间无关联（p=0.24）。按剂量五分位数分析时，与 0.00-0.09Gy 相比，0.10-0.29Gy 时正确结论的比值比增加了两倍，而在 0.3-24Gy 时则降低（线性趋势 p 值=0.99）。
在接受切尔诺贝利事故放射性碘照射的年轻白俄罗斯人群中，甲状腺活检对诊断 PTC 的预测值未受到辐射暴露水平的显著影响。
