甲状腺细胞病理学Bethesda报告系统的临床应用:肿瘤专科医院5729例样本的回顾性分析

Implementation of the Bethesda system for reporting the thyroid cytopathology:study on 5729 cases from a cancer center

目的分析肿瘤专科医院甲状腺细胞病理学Bethesda报告系统的数据特点,评价甲状腺细针穿刺(fine needle aspiration,FNA)的诊断能力。方法回顾性分析2017年1月至2018年12月中国医学科学院肿瘤医院行甲状腺FNA检查的5729个组织的临床资料,来自5011例患者,其中男1174例,女3837例,年龄7~88岁,中位年龄45岁。以术后组织病理学结果为金标准,分析Bethesda分级系统各诊断级别的恶性风险和甲状腺FNA的诊断能力。结果5729个细胞学诊断包括:无法诊断或标本不满意(nondiagnostic or unsatisfactory,ND/UNS)456个(8.0%),良性(benign)1055个(18.4%),意义不明确的非典型病变或意义不明确的滤泡性病变(atypia of undetermined significance or follicular lesion of undetermined significance,AUS/FLUS)409个(7.1%),滤泡性肿瘤或可疑滤泡性肿瘤(follicular neoplasm or suspicious for a follicular neoplasm,FN/SFN)80个(1.4%),可疑恶性(suspicious for malignancy,SUS)982个(17.1%),恶性(malignant)2747个(47.9%)。3239个有术后病理结果,其中恶性者3109个(95.99%)。各诊断级别的恶性风险分别为:ND/UNS 75.00%,良性40.91%,AUS/FLUS 77.67%,FN/SFN 41.67%,SUS 96.86%,恶性99.96%。FNA诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为98.8%、60.5%、97.7%、98.9%和59.1%。结论肿瘤专科医院甲状腺Bethesda报告系统的数据具有恶性诊断占比高和各诊断级别恶性风险高的特点。FNA诊断准确性高,且有较高的阳性预测值。

Objective To analyze the data of the Bethesda system for reporting thyroid cytopathology applied in a comprehensive cancer center and to evaluate the diagnostic ability of fine needle aspiration(FNA).Methods We retrospectively reviewed the medical records of 5729 cases applying this reporting system at Cancer Hospital,Chinese Academy of Medical Sciences.The series were from 5011 patients including 1174 men and 3837 women,and their median age was 45 years(range,7-88 years).FNA results were correlated with final histological diagnosis after surgery and the accuracy of FNA diagnosis and the malignancy rates for each of categories were also analyzed.Results Among 5729 thyroid aspirates,aside from 456(8.0%)cases with nondiagnostic or unsatisfactory(ND/UNS)outcomes,1055(18.4%)cases were benign,409(7.1%)cases showed atypical of undetermined significance or follicular lesions with undetermined significance(AUS/FLUS),80(1.4%)cases were follicular neoplasm or suspicious for follicular neoplasm(FN/SFN),982(17.1%)cases were suspicious for malignancy(SUS),and 2747 cases were malignant(47.9%).Of 5729 cases,3239 had received thyroidectomies after FNA,95.99%of them were proven histologically to be malignant,with following malignancy rates in individual FNA categories:ND/UNS 75.00%;benign 40.91%;AUS/FLUS 77.67%;FN/SFN 41.67%;SUS 96.86%;and malignant 99.96%.FNA predicted malignancy with sensitivity,specificity,accuracy,positive predictive value and negative predictive values of 98.8%,60.5%,97.7%,98.9%and 59.1%,respectively.Conclusions The data of the Bethesda reporting system indicates high proportion of malignant diagnosis and high risk of malignancy at all FNA diagnostic categories.FNA offers high diagnostic accuracy and positive predictive value for the diagnosis of thyroid diseases.