PDF(Pubmed)
Abstract：
UNASSIGNED: The 2015 American Thyroid Association (ATA) Guidelines recommend the following size cut-offs based on sonographic appearances for subjecting nodules to fine-needle aspiration (FNA) biopsy: low risk: 15 mm and intermediate risk and high risk: 10 mm.
UNASSIGNED: We conducted a \'real-world\' study evaluating the diagnostic performance of the ATA cut-offs against increased thresholds, in the interest of safely limiting FNAs.
UNASSIGNED: We performed a retrospective analysis of prospectively collected data on 604 nodules which were sonographically risk-stratified as per the ATA Guidelines and subsequently subjected to ultrasound-guided FNA. Nodules were cytologically stratified into \'benign\' (Bethesda class 2) and \'non-benign\' (Bethesda classes 3-6). We obtained the negative predictive value (NPV), accuracy, FNAs that could be spared, missed \'non-benign\' cytologies and missed carcinomas on histology, according to the ATA cut-offs compared to higher cut-offs.
UNASSIGNED: In low-risk nodules, the high performance of NPV (≈91%) is unaffected by increasing the cut-off to 25 mm, and accuracy improves by 39.4%; 46.8% of FNAs could be spared at the expense of few missed B3-B6 cytologies (7.9%) and no missed carcinomas. In intermediate-risk nodules, a 15 mm cut-off increases the NPV by 11.3% and accuracy by 40.7%. The spared FNAs approach 50%, while B3-B6 cytologies are minimal, with no missed carcinomas. In high-risk nodules, low NPV (<35%) and accuracy (<46%) were obtained regardless of cut-off. Moreover, the spared FNAs achieved at higher cut-offs involved numerous missed \'non-benign\' cytologies and carcinomas.
UNASSIGNED: It would be clinically safe to increase the ATA cut-offs for FNA in low-risk nodules to 25 mm and in intermediate-risk nodules to 15 mm.
UNASSIGNED: We conducted a \'real-world\' study evaluating the diagnostic performance of the ATA cut-offs against increased thresholds, in the interest of safely limiting FNAs.
UNASSIGNED: We performed a retrospective analysis of prospectively collected data on 604 nodules which were sonographically risk-stratified as per the ATA Guidelines and subsequently subjected to ultrasound-guided FNA. Nodules were cytologically stratified into \'benign\' (Bethesda class 2) and \'non-benign\' (Bethesda classes 3-6). We obtained the negative predictive value (NPV), accuracy, FNAs that could be spared, missed \'non-benign\' cytologies and missed carcinomas on histology, according to the ATA cut-offs compared to higher cut-offs.
UNASSIGNED: In low-risk nodules, the high performance of NPV (≈91%) is unaffected by increasing the cut-off to 25 mm, and accuracy improves by 39.4%; 46.8% of FNAs could be spared at the expense of few missed B3-B6 cytologies (7.9%) and no missed carcinomas. In intermediate-risk nodules, a 15 mm cut-off increases the NPV by 11.3% and accuracy by 40.7%. The spared FNAs approach 50%, while B3-B6 cytologies are minimal, with no missed carcinomas. In high-risk nodules, low NPV (<35%) and accuracy (<46%) were obtained regardless of cut-off. Moreover, the spared FNAs achieved at higher cut-offs involved numerous missed \'non-benign\' cytologies and carcinomas.
UNASSIGNED: It would be clinically safe to increase the ATA cut-offs for FNA in low-risk nodules to 25 mm and in intermediate-risk nodules to 15 mm.
摘要：
背景：2015年美国甲状腺协会（ATA）指南建议根据超声表现对结节进行细针穿刺（FNA）活检采用以下尺寸截止：低风险15mm，中等风险和高风险10mm。
目的：我们进行了一项“真实世界”研究，评估了ATA截止值对增加阈值的诊断性能，为了安全限制FNA。
方法：我们对前瞻性收集的604个结节的数据进行了回顾性分析，这些结节根据ATA指南进行了超声危险分层，随后接受了超声引导下的FNA检查。结节在细胞学上分为“良性”（Bethesda2级）和“非良性”（Bethesda3-6级）。我们获得了负预测值(NPV)，准确度,可以幸免的FNA，错过了“非良性”细胞学和组织学上错过的癌，根据ATA的截止值，与较高的截止值相比。
结果：在低风险结节中，净现值的高性能(≈91%)不受截止值增加到25mm的影响，准确性提高了39.4%;46.8%的FNA可以以很少错过B3-B6细胞学(7.9%)和没有错过的癌症为代价。在中等风险结节中，15mm的截止值会使净现值增加11.3%，精度增加40.7%。幸免的FNA接近50%，虽然B3-B6细胞学很少，没有遗漏的癌症。在高风险结节中，获得低净现值(<35%)和准确度(<46%)，而与截止值无关。此外，在较高截止时间获得的备用FNA涉及许多错过的“非良性”细胞学和癌。
结论：在低风险结节中将FNA的ATA截止值提高到25mm，在中等风险结节中提高到15mm是临床安全的。
目的：我们进行了一项“真实世界”研究，评估了ATA截止值对增加阈值的诊断性能，为了安全限制FNA。
方法：我们对前瞻性收集的604个结节的数据进行了回顾性分析，这些结节根据ATA指南进行了超声危险分层，随后接受了超声引导下的FNA检查。结节在细胞学上分为“良性”（Bethesda2级）和“非良性”（Bethesda3-6级）。我们获得了负预测值(NPV)，准确度,可以幸免的FNA，错过了“非良性”细胞学和组织学上错过的癌，根据ATA的截止值，与较高的截止值相比。
结果：在低风险结节中，净现值的高性能(≈91%)不受截止值增加到25mm的影响，准确性提高了39.4%;46.8%的FNA可以以很少错过B3-B6细胞学(7.9%)和没有错过的癌症为代价。在中等风险结节中，15mm的截止值会使净现值增加11.3%，精度增加40.7%。幸免的FNA接近50%，虽然B3-B6细胞学很少，没有遗漏的癌症。在高风险结节中，获得低净现值(<35%)和准确度(<46%)，而与截止值无关。此外，在较高截止时间获得的备用FNA涉及许多错过的“非良性”细胞学和癌。
结论：在低风险结节中将FNA的ATA截止值提高到25mm，在中等风险结节中提高到15mm是临床安全的。
