Hirokawa Mitsuyoshi, Katoh Ryohei, Amano Takashi, Chiba Tomohiro, Yamazaki Naoko, Satoh Shinya, Towata Miyuki, Ohi Yasuyo, Maeda Yukari, Fukushima Mitsuhiro, Sasaki Eiji, Yasuoka Hironao, Higuchi Miyoko, Suzuki Ayana, Akamizu Takashi
Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan.
Department of Pathology, Ito Hospital, Shibuya, Japan.
Cytojournal. 2025 May 15;22:55. doi: 10.25259/Cytojournal_229_2024. eCollection 2025.
The Japanese System for Reporting Thyroid Cytopathology (JSRTC) does not include the risks of malignancies (ROMs) or recommended clinical management. This multi-institutional study aimed to determine the frequency, re-aspiration rate, resection rate, ROM, and clinical management options in seven different categories.
For 15,495 cases of thyroid fine-needle aspiration performed at seven Japanese institutions without molecular testing, the frequency, re-aspiration rate, resection rate, ROM, and clinical management options of each diagnostic category were examined. The categorization was based on JSRTC, and cases were subdivided into those with nuclear atypia and other subtypes for undetermined significance.
Re-aspiration of unsatisfactory and undermined significance diagnostic categories was mainly performed for cases of suspected malignancy on ultrasound. The median re-aspiration rate of cyst fluid nodules was 4.9%, which was significantly different from that (17.8%) of unsatisfactory cases ( < 0.05). The resected ROMs for nodules that were suspicious for malignancy and malignant were 94.2% and 99.6%, respectively. The low resection rates of nodules that were suspicious for malignancy (77.8%) and malignant (70.8%) could be attributed to active surveillance for low-risk papillary microcarcinoma. The overall ROMs of unsatisfactory, cyst fluid, benign, undetermined significance, and follicular neoplasms were 4.5%, 0.4%, 0.7%, 16.7%, and 11.4%, respectively. In the subtype of undetermined significance, the overall ROM of nuclear atypia (27.6%) was higher than that of the others (6.7%).
Overall, this study determines the frequency, ROM, and recommended clinical management for thyroid cytopathology in Japan. These results were different from those proposed by the Bethesda System for Reporting Thyroid Cytopathology. In the future, our results will be helpful in the revision of JSRTC and will contribute to improving the outcomes among Japanese patients with thyroid nodules.
日本甲状腺细胞病理学报告系统（JSRTC）未纳入恶性肿瘤风险（ROMs）或推荐的临床管理内容。这项多机构研究旨在确定七个不同类别中的频率、再次穿刺率、切除率、ROMs以及临床管理选项。
对日本七家机构进行的15495例未进行分子检测的甲状腺细针穿刺病例，检查了每个诊断类别的频率、再次穿刺率、切除率、ROMs以及临床管理选项。分类基于JSRTC，病例被细分为具有核异型性的病例和其他意义未明的亚型。
对不满意和意义未明诊断类别的再次穿刺主要针对超声怀疑恶性的病例进行。囊液结节的再次穿刺率中位数为4.9%，与不满意病例的再次穿刺率（17.8%）有显著差异（<0.05）。可疑恶性和恶性结节的切除ROMs分别为94.2%和99.6%。可疑恶性（77.8%）和恶性（70.8%）结节的低切除率可归因于对低风险乳头状微小癌的主动监测。不满意、囊液、良性、意义未明和滤泡性肿瘤的总体ROMs分别为4.5%、0.4%、0.7%、16.7%和11.4%。在意义未明的亚型中，核异型性的总体ROM（27.6%）高于其他亚型（6.7%）。
总体而言，本研究确定了日本甲状腺细胞病理学的频率、ROMs以及推荐的临床管理。这些结果与美国国立综合癌症网络（Bethesda）甲状腺细胞病理学报告系统提出的结果不同。未来，我们的结果将有助于修订JSRTC，并有助于改善日本甲状腺结节患者的治疗效果。
