意大利甲状腺细胞学分类和报告共识(ICCRTC)包括六个诊断类别(TIR1/1C,TIR2,TIR3A,TIR3B,TIR4和TIR5),每种都表明恶性肿瘤的风险不同。这项单中心回顾性研究的目的是评估作者机构中ICCRTC类别的分布并评估其细胞组织学相关性。
作者回顾性收集了37,371例甲状腺结节的连续细胞学报告,并描述了不同细胞学类别的临床病理特征。在一部分患者中,细胞学诊断也与组织学结果进行了比较。
细胞学分类分布如下:非诊断性,15.6%;良性,66.5%;低风险不确定,10%(TIR3A);高风险不确定,3.5%(TIR3B);可疑,1.7%;和恶性,2.6%。根据组织学,在非诊断类别中,恶性肿瘤的风险非常高(29.8%),年轻男性患者更容易接触恶性肿瘤,在良性结节(7.8%)和不确定结节中相对较高(TIR3A中为32.5%;TIR3B中为52.1%),主要是因为滤泡结构在恶性肿瘤中的高患病率。在组织学上,可疑和恶性类别的恶性率分别为92.4%和99.3%,分别;在这些类别中,甲状腺乳头状癌的侵袭性变异主要被诊断出来。
在本系列中,非诊断性结节患病率高,令人惊讶的是,恶性率高。具有滤泡结构的恶性肿瘤代表了良性和不确定结节的诊断陷阱。可疑和恶性类别对恶性肿瘤具有高度特异性。重要的是,ICCRTC在确定甲状腺癌的术前侵袭性组织学类型方面具有很高的可靠性.
The Italian
Consensus for the Classification and Reporting of Thyroid
Cytology (ICCRTC) includes six diagnostic categories (TIR 1/1C, TIR 2, TIR 3A, TIR 3B, TIR 4, and TIR 5), each indicating a different risk of malignancy. The objective of this monocentric retrospective study was to evaluate the distribution of the ICCRTC classes at the authors\' institution and assess their cytohistologic correlations.
The authors retrospectively collected 37,371 consecutive cytologic reports of thyroid nodules and described the clinical-pathologic features of the different cytologic categories. The cytologic diagnoses also were compared with histologic outcomes in a subset of patients.
The cytologic classes were distributed as follows: nondiagnostic, 15.6%; benign, 66.5%; low-risk indeterminate, 10% (TIR 3A); high-risk indeterminate, 3.5% (TIR 3B); suspicious, 1.7%; and malignant, 2.6%. According to histology, the risk of malignancy was very high in the nondiagnostic category (29.8%), with young male patients more exposed to malignancy, and it was relatively high among benign (7.8%) and indeterminate nodules (32.5% in TIR 3A; 52.1% in TIR 3B), mainly because of the high prevalence of follicular architecture in malignant tumors. On histology, the malignancy rates were 92.4% and 99.3% for the suspicious and malignant categories, respectively; aggressive variants of papillary thyroid carcinoma were mostly diagnosed in these categories.
In this series, nondiagnostic nodules showed high prevalence and, surprisingly, high malignancy rates. Malignant tumors with follicular architecture represented a diagnostic pitfall in benign and indeterminate nodules. The suspicious and malignant categories had high specificity for malignancy. Importantly, the ICCRTC had high reliability for identifying preoperatively aggressive histotypes of thyroid carcinoma.