Paja M, Del Cura J L, Zabala R, Korta I, Gutiérrez Mª T, Expósito A, Ugalde A
Endocrinology Department, Hospital Universitario Basurto, OSI Bilbao-Basurto, Bilbao, Spain.
University of the Basque Country, UPV/EHU, Leioa, Spain.
J Endocrinol Invest. 2025 Apr;48(4):895-904. doi: 10.1007/s40618-024-02508-x. Epub 2024 Nov 22.
To propose a simplified histological classification for core-needle biopsy (CNB) of thyroid nodules with four diagnostic categories (DC) and provide the risk of malignancy (ROM) and the expected incidence for each DC. There is no uniform scheme for categorizing CNB specimens, except for a Korean diagnostic classification similar to the Bethesda system for FNAC.
Data from a single institution using CNB as a routine diagnostic tool for thyroid nodules. Biopsies were classified as non-diagnostic, benign, follicular tumour (FT) or malignant. The frequency of each DC and the correlation with surgical pathology of nodules undergoing surgery after CNB were evaluated.
Of 6284 CNBs on 5782 nodules [195 (3.1%) non-diagnostic, 5043 (80.3%) benign, 435 (6.9%) FT and 611 (9.7%) malignant], 1914 nodules (33.1%) underwent surgery after 2016 CNBs: 48 non-diagnostic, 1035 benign, 355 FT and 578 malignant. Malignancy was diagnosed after surgery in 11 non-diagnostic (ROM: 22.9%), 23 benign (ROM: 2.2%), 44 FT (ROM: 12.4%, 11.5% excluding low-grade malignancy) and 568 malignant CNBs (ROM: 98.3%, 93.8% excluding low-grade malignancy). Sensitivity and positive predictive value for malignancy of FT or malignant CNB were 94.7% and 65.6%, and for thyroid neoplasm (adenoma or carcinoma) were 93.2% and 92.6%.
Our diagnostic classification for CNB of thyroid nodules has a high diagnostic accuracy with a low rate of indeterminate categories. This classification, applied in a Western practice, shows a low ROM for nodules classified as follicular tumours, which could be improved with immunohistochemical studies.
提出一种简化的甲状腺结节粗针穿刺活检（CNB）组织学分类方法，分为四个诊断类别（DC），并给出每个类别的恶性风险（ROM）及预期发生率。除了一种类似于甲状腺细针穿刺活检（FNAC）的贝塞斯达系统的韩国诊断分类外，目前尚无统一的CNB标本分类方案。
来自单一机构的数据，该机构将CNB作为甲状腺结节的常规诊断工具。活检分为非诊断性、良性、滤泡性肿瘤（FT）或恶性。评估每个DC的频率以及与CNB后接受手术的结节手术病理的相关性。
对5782个结节进行了6284次CNB[195例（3.1%）非诊断性，5043例（80.3%）良性，435例（6.9%）FT和611例（9.7%）恶性]，其中1914个结节（33.1%）在2016次CNB后接受了手术：48例非诊断性，1035例良性，355例FT和578例恶性。手术后诊断为恶性的有11例非诊断性（ROM：22.9%），23例良性（ROM：2.2%），44例FT（ROM：12.4%，排除低级别恶性肿瘤后为11.5%）和568例恶性CNB（ROM：98.3%，排除低级别恶性肿瘤后为93.8%）。FT或恶性CNB对恶性肿瘤的敏感性和阳性预测值分别为94.7%和65.6%，对甲状腺肿瘤（腺瘤或癌）的敏感性和阳性预测值分别为93.2%和92.6%。
我们的甲状腺结节CNB诊断分类具有较高的诊断准确性，不确定类别的发生率较低。这种分类方法应用于西方实践中，对于分类为滤泡性肿瘤的结节显示出较低的ROM，通过免疫组织化学研究可能会有所改善。
