Objective:To evaluate the diagnostic utility of The Bethesda System for Reporting Thyroid Cytology(TBSRTC)at Peking University Cancer Hospital,the incidence of noninvasive follicular thyroid neoplasms with papillary-l...Objective:To evaluate the diagnostic utility of The Bethesda System for Reporting Thyroid Cytology(TBSRTC)at Peking University Cancer Hospital,the incidence of noninvasive follicular thyroid neoplasms with papillary-like nuclear features(NIFTP),and the impact of reclassification on cytopathological outcomes.Methods:We performed a retrospective study of thyroid fine-needle aspiration(FNA)cases between April 2014 and March 2019.The FNA results were classified according to TBSRTC.Post-surgery histological findings were followed up.Results:A total of 2,781 thyroid FNAs were performed.The incidences of the 6 diagnostic categories(DCs I-VI)were 14.8%,17.1%,15.8%,2.3%,11.6%and 38.5%,respectively.A total of 1,122 patients(40.3%)had corresponding histological results.NIFTP accounted for 0.4%of papillary thyroid carcinoma(PTC)cases,and there was no significant difference in the risk of malignancy(ROM)for each TBSRTC DC between"NIFTP=carcinoma(Ca)"and"NIFTP≠Ca".When"NIFTP=Ca",the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of TBSRTC were 98.0%,84.0%,99.4%,58.3%,and97.5%,respectively.When"NIFTP≠Ca",the sensitivity,specificity,PPV,NPV and accuracy of the TBSRTC were 98.1%,81.5%,99.3%,61.1%,and 97.5%,respectively.Conclusions:TBSRTC is effective in the preoperative diagnosis of thyroid nodules in Peking University Cancer Hospital.The impact of the reclassification of NIFTP on cytopathological outcomes is limited because of its low incidence,and the revised ROMs are not suitable for Asian patients.展开更多
Objective: Bethesda System for Reporting Thyroid Cytopathology(BSRTC) categories Ⅰ, Ⅲ, and Ⅴaccount for a significant proportion of fine needle aspiration cytology(FNAC) diagnoses. This study aimed to compare the d...Objective: Bethesda System for Reporting Thyroid Cytopathology(BSRTC) categories Ⅰ, Ⅲ, and Ⅴaccount for a significant proportion of fine needle aspiration cytology(FNAC) diagnoses. This study aimed to compare the diagnostic efficacy of BRAF^(V600E) mutation and the Thyroid Imaging Reporting and Data System(TIRADS) classification in differentiating papillary thyroid cancers(PTCs) from benign lesions among BSRTC I, III, and V nodules.Methods: A total of 472 patients with 479 nodules were enrolled in this prospective study. Ultrasound, BRAF^(V600E) mutation testing, and FNAC were performed in each nodule, followed by surgery or regular ultrasound examination.Results: In the BSRTC I category, BRAF^(V600E) showed similar sensitivity, higher specificity, and lower accuracy when compared with TIRADS. In the BSRTC III/V category, the sensitivity, specificity, and accuracy of BRAF^(V600E) were similar to those of TIRADS. In comparison to BRAF^(V600E) alone, the combination of the two methods significantly improved sensitivity(BSRTC Ⅰ:93.6% vs. 67.7%, P < 0.01; BSRTC Ⅲ: 93.8% vs. 75.0%, P < 0.01; BSRTC V: 96.0% vs. 85.3%, P < 0.001). When compared with TIRADS alone, the combination improved sensitivity in BSRTC Ⅰ nodules(93.6% vs. 74.2%, P < 0.05), increased sensitivity and decreased accuracy in BSRTC III nodules(93.8% vs. 75.0%, P < 0.01, 91.0% vs. 93.6%, P < 0.01), and improved both sensitivity and accuracy in BSRTC V nodules(96.0% vs. 82.0%, P < 0.001; 94.2% vs. 81.3%, P < 0.001).Conclusions: BRAF^(V600E) exhibited higher specificity and lower accuracy compared with TIRADS in BSRTC Ⅰ nodules, while the two methods showed similar diagnostic value in BSRTC Ⅲ/Ⅴ nodules. The combination of the two methods distinctly improved sensitivity in the diagnosis of PTCs in BSRTC Ⅰ, Ⅲ, and Ⅴ nodules.展开更多
AIM To stratify the malignancy risks in thyroid nodules in a tertiary care referral center using the Bethesda system. METHODS From January, 2012 to December, 2014, a retrospective analysis was performed among 1188 pat...AIM To stratify the malignancy risks in thyroid nodules in a tertiary care referral center using the Bethesda system. METHODS From January, 2012 to December, 2014, a retrospective analysis was performed among 1188 patients(15-90 years) who had 1433 thyroid nodules and fine-needle aspiration at Prince Sultan Military Medical City, Saudi Arabia. All thyroid cyto-pathological slides and ultra sound reports were reviewed and classified according to the Bethesda System for Reporting Thyroid Cytopathology. Age, gender, cytological features and histological types of the thyroid cancer were collected from patients' medical chart and cytopathology reports. RESULTS There were 124 total cases of malignancy on resection, giving an overall surgical yield malignancy of 33.6%.Majority of the thyroid cancer nodules(n = 57, 46%) in Bethesda VI category followed by Bethesda IV(n = 25, 20.2%). Almost 40% of the cancer nodules in 31-45 age group in both sex. Papillary thyroid carcinoma(PTC) was the most common form of thyroid cancer among the study population(111, 89.6%) followed by 8.9% of follicular thyroid carcinoma(FTC), 0.8% of medullary carcinoma and 0.8% of anaplastic carcinoma. Among the Bethesda IV category 68% thyroid nodules were PTC and 32% FTC. CONCLUSION The malignancy values reported in our research were constant and comparable with the results of other published data with respect to the risk of malignancy. Patients with follicular neoplasm/suspicious for follicular neoplasm and suspicious of malignancy categories, total thyroidectomy is indicted because of the substantial risk of malignancy.展开更多
目的分析细针穿刺细胞学检查(FNAC)BethesdaⅢ类甲状腺结节结合组织Galectin-3分子表达和超声造影(CEUS)在鉴别良恶性中的应用价值。方法选择行FNAC检查诊断为BethesdaⅢ类甲状腺结节患者110例(140个结节),其中男性52例,女性58例;年龄25...目的分析细针穿刺细胞学检查(FNAC)BethesdaⅢ类甲状腺结节结合组织Galectin-3分子表达和超声造影(CEUS)在鉴别良恶性中的应用价值。方法选择行FNAC检查诊断为BethesdaⅢ类甲状腺结节患者110例(140个结节),其中男性52例,女性58例;年龄25~64岁,平均年龄45.5岁。所有组织分别进行Galectin-3分子免疫组织化学染色和CEUS两项检查,诊断结节的良恶性,比较良性组和恶性组常规超声甲状腺影像报告与数据系统(TI-RADS)分级、Galectin-3表达阳性率、CEUS增强模式及CEUS定量参数。采用受试者工作特性(ROC)曲线评估鉴别恶性结节的准确度。结果经细胞病理学确诊良性组患者80例,良性结节100个;恶性组患者30例,恶性结节40个。恶性组与良性组患者性别、年龄、TI-RADS分级、结节直径比较差异无统计学意义(P>0.05)。恶性组结节Galectin-3表达阳性率显著高于良性组(60.0%vs 30.0%),CEUS增强模式以早期低增强为主,CEUS定量评估软件测量结节峰值强度(PI)值低于良性组(5.32±1.46 vs 6.79±1.88)(χ^(2)=10.853、25.239,t=4.968,P<0.05)。以Galectin-3表达阳性联合CEUS检查作为评估BethesdaⅢ类甲状腺结节良恶性的主要依据,手术病理诊断结果为金标准,得出诊断恶性结节的准确度61.82%(34/55),灵敏度85.00%(34/40),特异度79.00%(79/100),阳性预测值61.82%(34/55)和阴性预测值92.94%(79/85)。采用ROC曲线进一步验证联合Galectin-3表达阳性和CEUS检查诊断BethesdaⅢ类甲状腺结节良恶性,结果准确度为82.5%,灵敏度80.9%,特异度75.6%。结论CEUS定量检查联合结节Galectin-3分子表达能够为FNAC诊断BethesdaⅢ类甲状腺结节的良恶性质提供更加丰富的生物学信息,CEUS增强模式以早期低增强为主,Galectin-3阳性表达有助于结节恶性的判断。展开更多
目的探讨甲状腺BethesdaⅢ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法收集356例BethesdaⅢ结节患者,对其诊断原因,ROM及亚分类进行总结分析。结果在97例手术切除标本中,72例恶性...目的探讨甲状腺BethesdaⅢ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法收集356例BethesdaⅢ结节患者,对其诊断原因,ROM及亚分类进行总结分析。结果在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),BethesdaⅢ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。BethesdaⅢ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P<0.05)。结论BethesdaⅢ类的诊断具有一定的主观性和经验性,而对BethesdaⅢ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。展开更多
文摘Objective:To evaluate the diagnostic utility of The Bethesda System for Reporting Thyroid Cytology(TBSRTC)at Peking University Cancer Hospital,the incidence of noninvasive follicular thyroid neoplasms with papillary-like nuclear features(NIFTP),and the impact of reclassification on cytopathological outcomes.Methods:We performed a retrospective study of thyroid fine-needle aspiration(FNA)cases between April 2014 and March 2019.The FNA results were classified according to TBSRTC.Post-surgery histological findings were followed up.Results:A total of 2,781 thyroid FNAs were performed.The incidences of the 6 diagnostic categories(DCs I-VI)were 14.8%,17.1%,15.8%,2.3%,11.6%and 38.5%,respectively.A total of 1,122 patients(40.3%)had corresponding histological results.NIFTP accounted for 0.4%of papillary thyroid carcinoma(PTC)cases,and there was no significant difference in the risk of malignancy(ROM)for each TBSRTC DC between"NIFTP=carcinoma(Ca)"and"NIFTP≠Ca".When"NIFTP=Ca",the sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV),and accuracy of TBSRTC were 98.0%,84.0%,99.4%,58.3%,and97.5%,respectively.When"NIFTP≠Ca",the sensitivity,specificity,PPV,NPV and accuracy of the TBSRTC were 98.1%,81.5%,99.3%,61.1%,and 97.5%,respectively.Conclusions:TBSRTC is effective in the preoperative diagnosis of thyroid nodules in Peking University Cancer Hospital.The impact of the reclassification of NIFTP on cytopathological outcomes is limited because of its low incidence,and the revised ROMs are not suitable for Asian patients.
基金supported by grants from the National Natural Science Foundation of China (Grant No. 81261120566)Jiangsu Province Key Medical Personnel Project (Grant No. RC2011068)+2 种基金333 Projects in the Fourth Phase of Jiangsu Province (Grant No. BRA2015389)Jiangsu Province "Six First Project" Research Program (Grant No. LGY2016004)the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘Objective: Bethesda System for Reporting Thyroid Cytopathology(BSRTC) categories Ⅰ, Ⅲ, and Ⅴaccount for a significant proportion of fine needle aspiration cytology(FNAC) diagnoses. This study aimed to compare the diagnostic efficacy of BRAF^(V600E) mutation and the Thyroid Imaging Reporting and Data System(TIRADS) classification in differentiating papillary thyroid cancers(PTCs) from benign lesions among BSRTC I, III, and V nodules.Methods: A total of 472 patients with 479 nodules were enrolled in this prospective study. Ultrasound, BRAF^(V600E) mutation testing, and FNAC were performed in each nodule, followed by surgery or regular ultrasound examination.Results: In the BSRTC I category, BRAF^(V600E) showed similar sensitivity, higher specificity, and lower accuracy when compared with TIRADS. In the BSRTC III/V category, the sensitivity, specificity, and accuracy of BRAF^(V600E) were similar to those of TIRADS. In comparison to BRAF^(V600E) alone, the combination of the two methods significantly improved sensitivity(BSRTC Ⅰ:93.6% vs. 67.7%, P < 0.01; BSRTC Ⅲ: 93.8% vs. 75.0%, P < 0.01; BSRTC V: 96.0% vs. 85.3%, P < 0.001). When compared with TIRADS alone, the combination improved sensitivity in BSRTC Ⅰ nodules(93.6% vs. 74.2%, P < 0.05), increased sensitivity and decreased accuracy in BSRTC III nodules(93.8% vs. 75.0%, P < 0.01, 91.0% vs. 93.6%, P < 0.01), and improved both sensitivity and accuracy in BSRTC V nodules(96.0% vs. 82.0%, P < 0.001; 94.2% vs. 81.3%, P < 0.001).Conclusions: BRAF^(V600E) exhibited higher specificity and lower accuracy compared with TIRADS in BSRTC Ⅰ nodules, while the two methods showed similar diagnostic value in BSRTC Ⅲ/Ⅴ nodules. The combination of the two methods distinctly improved sensitivity in the diagnosis of PTCs in BSRTC Ⅰ, Ⅲ, and Ⅴ nodules.
文摘AIM To stratify the malignancy risks in thyroid nodules in a tertiary care referral center using the Bethesda system. METHODS From January, 2012 to December, 2014, a retrospective analysis was performed among 1188 patients(15-90 years) who had 1433 thyroid nodules and fine-needle aspiration at Prince Sultan Military Medical City, Saudi Arabia. All thyroid cyto-pathological slides and ultra sound reports were reviewed and classified according to the Bethesda System for Reporting Thyroid Cytopathology. Age, gender, cytological features and histological types of the thyroid cancer were collected from patients' medical chart and cytopathology reports. RESULTS There were 124 total cases of malignancy on resection, giving an overall surgical yield malignancy of 33.6%.Majority of the thyroid cancer nodules(n = 57, 46%) in Bethesda VI category followed by Bethesda IV(n = 25, 20.2%). Almost 40% of the cancer nodules in 31-45 age group in both sex. Papillary thyroid carcinoma(PTC) was the most common form of thyroid cancer among the study population(111, 89.6%) followed by 8.9% of follicular thyroid carcinoma(FTC), 0.8% of medullary carcinoma and 0.8% of anaplastic carcinoma. Among the Bethesda IV category 68% thyroid nodules were PTC and 32% FTC. CONCLUSION The malignancy values reported in our research were constant and comparable with the results of other published data with respect to the risk of malignancy. Patients with follicular neoplasm/suspicious for follicular neoplasm and suspicious of malignancy categories, total thyroidectomy is indicted because of the substantial risk of malignancy.
文摘目的分析细针穿刺细胞学检查(FNAC)BethesdaⅢ类甲状腺结节结合组织Galectin-3分子表达和超声造影(CEUS)在鉴别良恶性中的应用价值。方法选择行FNAC检查诊断为BethesdaⅢ类甲状腺结节患者110例(140个结节),其中男性52例,女性58例;年龄25~64岁,平均年龄45.5岁。所有组织分别进行Galectin-3分子免疫组织化学染色和CEUS两项检查,诊断结节的良恶性,比较良性组和恶性组常规超声甲状腺影像报告与数据系统(TI-RADS)分级、Galectin-3表达阳性率、CEUS增强模式及CEUS定量参数。采用受试者工作特性(ROC)曲线评估鉴别恶性结节的准确度。结果经细胞病理学确诊良性组患者80例,良性结节100个;恶性组患者30例,恶性结节40个。恶性组与良性组患者性别、年龄、TI-RADS分级、结节直径比较差异无统计学意义(P>0.05)。恶性组结节Galectin-3表达阳性率显著高于良性组(60.0%vs 30.0%),CEUS增强模式以早期低增强为主,CEUS定量评估软件测量结节峰值强度(PI)值低于良性组(5.32±1.46 vs 6.79±1.88)(χ^(2)=10.853、25.239,t=4.968,P<0.05)。以Galectin-3表达阳性联合CEUS检查作为评估BethesdaⅢ类甲状腺结节良恶性的主要依据,手术病理诊断结果为金标准,得出诊断恶性结节的准确度61.82%(34/55),灵敏度85.00%(34/40),特异度79.00%(79/100),阳性预测值61.82%(34/55)和阴性预测值92.94%(79/85)。采用ROC曲线进一步验证联合Galectin-3表达阳性和CEUS检查诊断BethesdaⅢ类甲状腺结节良恶性,结果准确度为82.5%,灵敏度80.9%,特异度75.6%。结论CEUS定量检查联合结节Galectin-3分子表达能够为FNAC诊断BethesdaⅢ类甲状腺结节的良恶性质提供更加丰富的生物学信息,CEUS增强模式以早期低增强为主,Galectin-3阳性表达有助于结节恶性的判断。
文摘目的探讨甲状腺BethesdaⅢ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法收集356例BethesdaⅢ结节患者,对其诊断原因,ROM及亚分类进行总结分析。结果在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),BethesdaⅢ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。BethesdaⅢ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P<0.05)。结论BethesdaⅢ类的诊断具有一定的主观性和经验性,而对BethesdaⅢ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。
