《甲状腺细胞病理学报告的贝塞斯达系统：儿童甲状腺结节的恶性风险》
The Bethesda System for Reporting Thyroid Cytopathology: Risk of Malignancy in Pediatric Thyroid Nodules.
作者信息
Pintos Sabrina de Los Angeles, Varela Florencia, Jaén Ana, Guillermo Alonso, Lobos Pablo Andres, Liberto Daniel Hernan
机构信息
Division of Pediatric Surgery, Hospital Italiano de Buenos Aires, Argentina.
Division of Pediatric General, Thoracic and Fetal Surgery, The Center for Fetal Research, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
出版信息
J Pediatr Surg. 2025 Mar;60(3):162126. doi: 10.1016/j.jpedsurg.2024.162126. Epub 2024 Dec 27.
INTRODUCTION
Thyroid nodules are infrequent findings in children, though malignancy rates are higher in this population. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) standardizes the reporting of thyroid fine needle aspiration (FNA) specimens and has become a global reference for assessing the risk of malignancy (ROM) of thyroid nodules. The 2023 update includes pediatric-specific risk predictions and management recommendations. Our study aimed to evaluate the ROM for each Bethesda (BT) category in our pediatric population and compare them with the 2023 TBSRTC update.
METHODS
This retrospective cohort study studied pediatric patients who underwent FNA from 2008 to 2023 at our tertiary care center. ROM was assessed by comparing each Bethesda category with histology after thyroid surgery or with long-term follow-up data for non-surgical cases. Comparison among our observed ROM and the 2023 TBSRTC was done by assessing whether the mean ROM from the 2023 TBSRTC fell within the 95 % Confidence Intervals (CIs) of our cohort's ROM for each Bethesda category.
RESULTS
165 patients with thyroid nodules underwent FNA and Bethesda system classification. 55 patients were excluded due to incomplete follow-up. Thyroid surgery was required in 58 patients. All Bethesda I nodules were benign, while malignancy rates (ROM) were 10.5 % for Bethesda II, 42.8 % for Bethesda IV, 87.5 % for Bethesda V, and 100 % for Bethesda VI. The mean follow-up was 58,2 months (±41,4 SD, range 6-170 months). The comparison of the ROM in our cohort with the 2023 Bethesda pediatric population reveals notable consistency across all Bethesda categories.
DISCUSSION
The ROM among patients with Bethesda II, IV, V, and VI was higher than reported in TBSRTC for adults and similar to those published in the 2023 TBSRTC for children. The development of updated pediatric-specific guidelines could have a significant impact on follow-up strategies and therapeutic algorithms.
TYPE OF STUDY
Prognosis Study.
LEVEL OF EVIDENCE
II (retrospective).
引言
甲状腺结节在儿童中并不常见，尽管该人群中的恶性肿瘤发生率较高。甲状腺细胞病理学报告的贝塞斯达系统（TBSRTC）规范了甲状腺细针穿刺（FNA）标本的报告，并已成为评估甲状腺结节恶性风险（ROM）的全球参考标准。2023年更新版包括针对儿科的风险预测和管理建议。我们的研究旨在评估儿科人群中每个贝塞斯达（BT）类别的ROM，并将其与2023年TBSRTC更新版进行比较。
方法
这项回顾性队列研究对2008年至2023年在我们三级医疗中心接受FNA的儿科患者进行了研究。通过将每个贝塞斯达类别与甲状腺手术后的组织学或非手术病例的长期随访数据进行比较来评估ROM。通过评估2023年TBSRTC的平均ROM是否落在我们队列中每个贝塞斯达类别的ROM的95%置信区间（CI）内，来对我们观察到的ROM与2023年TBSRTC进行比较。
结果
165例甲状腺结节患者接受了FNA和贝塞斯达系统分类。55例患者因随访不完整而被排除。58例患者需要进行甲状腺手术。所有贝塞斯达I类结节均为良性，而贝塞斯达II类的恶性率（ROM）为10.5%，贝塞斯达IV类为42.8%，贝塞斯达V类为87.5%，贝塞斯达VI类为100%。平均随访时间为58.2个月（±41.4标准差，范围6 - 170个月）。我们队列中的ROM与2023年贝塞斯达儿科人群的比较显示，所有贝塞斯达类别之间具有显著的一致性。
讨论
贝塞斯达II、IV、V和VI类患者的ROM高于TBSRTC中报道的成人ROM，与2023年TBSRTC中报道的儿童ROM相似。更新的儿科特定指南的制定可能会对随访策略和治疗算法产生重大影响。
研究类型
预后研究。
证据级别
II（回顾性）。
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