Noh Byeong-Joo, Kim Won Jun, Kim Jin Yub, Kim Ha Young, Lee Jong Cheol, Shim Myoung Sook, Song Yong Jin, Yoon Kwang Hyun, Jung In-Hye, Lee Hyo Sang, Paik Wooyul, Na Dong Gyu
Department of Pathology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Department of Endocrinology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
Endocrinol Metab (Seoul). 2025 Aug;40(4):610-622. doi: 10.3803/EnM.2024.2256. Epub 2025 May 28.
This study assessed risk stratification and diagnostic performance for malignancy in thyroid nodules diagnosed as follicular neoplasm (FN) based on core needle biopsy (CNB) subcategories.
A total of 313 consecutive nodules (>1 cm) diagnosed as FN on CNB with corresponding surgical histology were included. FN subcategories were classified retrospectively for nodules diagnosed before 2022 (retrospective dataset) and prospectively for nodules diagnosed since 2022 (prospective dataset). CNB subcategories were determined using histologic criteria based on architectural uniformity and nuclear atypia, as modified from the 2019 Korean CNB pathology guideline. The diagnostic performance of CNB subcategories, nodule size, and ultrasound risk stratification systems (RSSs) for malignancy was assessed.
CNB subcategory IVb showed a significantly higher malignancy risk compared to other subcategories in both datasets (34.5%-83.7% vs. 4.2%-13.6%, P<0.001). It was also identified as an independent predictor of malignancy in both datasets (P< 0.001), whereas nodule size and all ultrasound RSSs were not predictive of malignancy, including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) (P≥0.079). CNB subcategory IVb demonstrated higher sensitivity for malignancy and a lower surgical rate for benign nodules compared to the nodule size criterion (>2 cm). The combined criterion of CNB subcategory IVb or nodule size >3 cm identified all malignant tumors, excluding NIFTP, in the prospective dataset.
CNB subcategory IVb effectively stratifies malignancy risk in thyroid nodules and outperforms nodule size (>2 cm) and ultrasound RSSs in diagnostic performance. Non-IVb nodules ≤3 cm can be safely managed with ultrasound surveillance instead of immediate surgery.
本研究基于粗针穿刺活检（CNB）亚分类评估诊断为滤泡性肿瘤（FN）的甲状腺结节的恶性风险分层及诊断效能。
纳入313个经CNB诊断为FN且有相应手术组织学结果的连续结节（直径>1 cm）。对2022年前诊断的结节进行回顾性分类（回顾性数据集），对2022年及以后诊断的结节进行前瞻性分类（前瞻性数据集）。根据2019年韩国CNB病理指南修订版，基于结构一致性和核异型性的组织学标准确定CNB亚分类。评估CNB亚分类、结节大小及超声风险分层系统（RSS）对恶性肿瘤的诊断效能。
在两个数据集中，CNB亚分类IVb的恶性风险均显著高于其他亚分类（34.5%-83.7% 对 4.2%-13.6%，P<0.001）。在两个数据集中，它也被确定为恶性肿瘤的独立预测因素（P<0.001），而结节大小和所有超声RSS均不能预测恶性肿瘤，包括具有乳头样核特征的非侵袭性滤泡性甲状腺肿瘤（NIFTP）（P≥0.079）。与结节大小标准（>2 cm）相比，CNB亚分类IVb对恶性肿瘤的敏感性更高，对良性结节的手术率更低。在前瞻性数据集中，CNB亚分类IVb或结节大小>3 cm的联合标准可识别所有恶性肿瘤，但不包括NIFTP。
CNB亚分类IVb能有效分层甲状腺结节的恶性风险，在诊断效能上优于结节大小（>2 cm）和超声RSS。直径≤3 cm的非IVb结节可通过超声监测安全管理，而非立即手术。
