Department of Pathology, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey.
Department of Biostatistics, Faculty of Medicine, Trakya University, 22030, Edirne, Turkey.
Endocr Pathol. 2024 Mar;35(1):51-76. doi: 10.1007/s12022-024-09797-1. Epub 2024 Jan 27.
Significant interobserver variabilities exist for Bethesda category III: atypia of undetermined significance (AUS) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Thus, subcategorization of AUS including AUS "nuclear" and AUS "other" is proposed in the recent 3rd edition of TBSRTC. This study investigated the impact of the nuclear features/architectural features/nuclear score (NS) (3-tiered)/subcategories and subgroups on risk of malignancy (ROM) in thyroid fine-needle aspirations (FNA). 6940 FNAs were evaluated. 1224 (17.6%) cases diagnosed as AUS were reviewed, and 240 patients (initial FNAs of 260 nodules and 240 thyroidectomies) were included. Subcategories and subgroups were defined according to TBSRTC 2nd and 3rd editions. Histological diagnostic groups included nonneoplastic disease, benign neoplasm, low-risk neoplasm, and malignant neoplasm. Overall, ROM was 30.7%. ROM was significantly higher in FNAs with nuclear overlapping (35.5%), nuclear molding (56.9%), irregular contours (42.1%), nuclear grooves (74.1%), chromatin clearing (49.4%), and chromatin margination (57.7%), and these features were independent significant predictors for malignancy. FNAs with NS3 had significantly higher ROM (64.2%). Three-dimensional groups were significantly more frequent in malignant neoplasms (35.7%). ROM was significantly higher in AUS-nuclear subcategory (48.2%) and in AUS-nuclear and architectural subcategory (38.3%). The highest ROM was detected in AUS-nuclear1 subgroup (65.2%). ROM was significantly higher in the group including AUS-nuclear and AUS-nuclear and architectural subcategories, namely "high-risk group" than the group including other subcategories, namely "low-risk group" (42.0%vs 13.9%). In conclusion, subcategorization may not be the end point, and nuclear scoring and evaluation of architectural patterns according to strict criteria may provide data for remodeling of TBSRTC categories.
甲状腺细胞病理学报告的 Bethesda 系统（Bethesda System for Reporting Thyroid Cytopathology，TBSRTC）中，Bethesda Ⅲ类：意义不明确的非典型性（Atypia of Undetermined Significance，AUS）的观察者间差异具有显著意义。因此，在 TBSRTC 的第 3 版中提出了 AUS 的亚分类，包括 AUS“核型”和 AUS“其他”。本研究旨在调查甲状腺细针抽吸术（Fine-needle Aspiration，FNA）中核特征/结构特征/核评分（Nuclear Score，NS）（3 级）/亚分类和亚组对恶性肿瘤风险（Malignancy Risk，ROM）的影响。共评估了 6940 例 FNA，其中 1224 例（260 个结节的初始 FNA 和 240 例甲状腺切除术）诊断为 AUS。根据 TBSRTC 第 2 版和第 3 版定义了亚分类和亚组。组织学诊断组包括非肿瘤性疾病、良性肿瘤、低风险肿瘤和恶性肿瘤。总体而言，ROM 为 30.7%。核重叠（35.5%）、核成型（56.9%）、不规则轮廓（42.1%）、核沟（74.1%）、染色质清除（49.4%）和染色质边缘化（57.7%）的 FNA 的 ROM 显著更高，这些特征是恶性肿瘤的独立显著预测因素。NS3 的 FNA 的 ROM 显著更高（64.2%）。三维组在恶性肿瘤中更为常见（35.7%）。AUS-核亚类（48.2%）和 AUS-核和结构亚类（38.3%）的 ROM 显著更高。AUS-核 1 亚组的 ROM 最高（65.2%）。包括 AUS-核和 AUS-核和结构亚类的“高危组”的 ROM 显著高于包括其他亚类的“低危组”（42.0%比 13.9%）。总之，亚分类可能不是终点，根据严格标准进行核评分和结构模式评估可能为 TBSRTC 分类的重塑提供数据。
