Hameed Sayika, Khan Sabina, Hassan Mohd Jaseem, Husain Musharraf, Prakash Arun
Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, 110062 India.
Department of Pathology, JN Medical College AMU, Aligarh, India.
Indian J Otolaryngol Head Neck Surg. 2024 Oct;76(5):3930-3935. doi: 10.1007/s12070-024-04744-2. Epub 2024 May 24.
Bethesda System for reporting thyroid cytopathology established in 2009 was updated for the first time in 2017. Since its introduction very few studies have been done on the utility of recently introduced "The 2017 Bethesda System for Reporting Thyroid Cytopathology" (TBSRTC II) and estimation of risk of malignancy in various categories.
This was a prospective study done on thyroid lesions in which lesions were evaluated cytologically and classified according to TBSRTC II. Histopathological correlation was done, wherever possible. ROM was calculated for each Bethesda category in both ways as per TBSRTC II i.e. with NIFTP and excluding NIFTP from the malignant category.
Using 2017 TBSRTC, 190 cases of thyroid FNACs were classified into 6 diagnostic categories. Cytohistological correlation was available in 60 cases. ROM was calculated which changed only in category III and V as only these two categories showed one case each of NIFTP. However there was an overestimation of ROM in category II and III as there are selection biases and not all thyroid nodules underwent surgical resections.
To conclude, the risk of malignancy calculated in two ways in the recent 2017 Bethesda system may have higher clinical relevance as those lesions with high ROM are defined for surgical excision. Thus we recommend that "The 2017 Bethesda system for Reporting Thyroid Cytopathology" should be implemented uniformly in our country as it provides a homogenous and standardised terminology resulting in better management of patients with thyroid nodular disease.
2009年建立的甲状腺细胞病理学报告贝塞斯达系统于2017年首次更新。自引入以来，关于最近推出的“2017年甲状腺细胞病理学报告贝塞斯达系统”（TBSRTC II）的实用性以及各类别恶性风险评估的研究很少。
这是一项针对甲状腺病变的前瞻性研究，对病变进行细胞学评估并根据TBSRTC II进行分类。尽可能进行组织病理学相关性分析。按照TBSRTC II的两种方式计算每个贝塞斯达类别的恶性风险率（ROM），即包括非侵袭性滤泡性甲状腺肿瘤（NIFTP）和将NIFTP排除在恶性类别之外。
使用2017年TBSRTC，190例甲状腺细针穿刺活检（FNAC）病例被分为6个诊断类别。60例有细胞组织学相关性分析结果。计算了ROM，仅III类和V类发生了变化，因为只有这两类各有1例NIFTP。然而，II类和III类的ROM存在高估，因为存在选择偏倚，并非所有甲状腺结节都接受了手术切除。
总之，2017年最新贝塞斯达系统以两种方式计算的恶性风险可能具有更高的临床相关性，因为高ROM的病变被定义为手术切除对象。因此，我们建议在我国统一实施“2017年甲状腺细胞病理学报告贝塞斯达系统”，因为它提供了统一和标准化的术语，从而能更好地管理甲状腺结节疾病患者。
