Bethesda细胞病理报告系统在甲状腺细针穿刺中的应用

Application of Bethesda system for reporting cytology in thyroid fine needle aspiration

目的 :将Bethesda细胞病理报告系统(TBS)应用于甲状腺细针穿刺(FNA)细胞病理读片,提高FNA细胞病理诊断水平。方法:收集1 705份FNA细胞病理样本,同时对比分析其中66例接受外科手术的组织病理样本。结果:1 705份中病理片归为"无诊断价值"(N)、"良性"(B)、"不确定价值的不典型增生"(AUS)、"滤泡性肿瘤"(FN)、"怀疑恶性"(S)和"恶性"(M)的分别有295(17.30%)、1 291(75.72%)、30(1.76%)、19(1.11%)、36(2.11%)和34(1.99%)例。总体阳性细胞率82.70%。对66例同时接受FNA和手术的患者细胞和组织病理对比分析得出,前2类总体恶性可能性仅为11.11%,而后4类总体恶性可能性为63.33%,较前者显著升高(P<0.01)。FNA对恶性或癌前病变诊断的敏感性为82.61%,特异性为74.42%,阳性预测值为63.33%,阴性预测值为88.89%,假阳性率为25.58%,假阴性率为17.39%。结论:TBS类别中AUS、FN、S和M类恶性风险较高,对于指导临床实践有重要价值。

Objective：Application of the Bethesda system（TBS）for reporting thyroid cytology in fine needle aspiration（FNA）to improve the capability of cytopathological diagnosis. Methods：Totally 1 705 FNA cytopathological samples were analyzed from May2011 to Jun 2012. Sixty-six histological pathological samples from these patients were analyzed in the meantime. Results：According to TBS,1 705 FNA cytopathological samples were classified into six categories with 295（17.30%）as nondiagnostic（N）,1 291（75.72%）as benign（B）,30（1.76%）as atypia of undetermined significance（AUS）,19（1.11%）as follicular neoplasm（FN）,36（2.11%）as suspicious（S）and 34（1.99%）as malignant（M）. Total positive cell rate was 82.70%. It was concluded from the comparison of histopathological and cytopathological slides of 66 patients that the overall occurrence rate of malignancy was 11.11% in former two groups,which was significantly lower than that（63.33%） in latter four groups（P〈0.01）. The sensitivity,specificity,positive predictive value,negative predictive value,false positive rate and false negative rate for FNA in differentiation of benign and malignant lesions were calculated as 82.61%,74.42%,63.33%,88.89%,25.58% and 17.39%, respectively. Conclusion：TBS showed great importance in differentiation of benign and malignant thyroid lesions,with high probability of malignancy in AUS,FN,S and M groups.