背景:Bethesda甲状腺细胞病理学报告系统是可疑甲状腺结节的细针穿刺(FNA)细胞学检查的常用分类。最近在三个国际数据库中分析了每个类别的恶性肿瘤(ROM)风险。本文比较了比利时大批量转诊中心Bethesda分类的诊断性能。
方法:从2010年1月到2022年8月,所有连续的甲状腺手术都登记在前瞻性数据库中。患者和手术特点,术前贝塞斯达类别,并对术后病理结果进行分析。
结果:在2219例连续甲状腺手术中,1226例患者术前行FNA。甲状腺乳头状癌是最常见的恶性肿瘤(N=119,70.4%),其次是滤泡性(N=17,10.1%)和甲状腺髓样癌(N=15,8.9%)。在46例(3.8%)患者中偶然发现了甲状腺微乳头状癌。贝塞斯达第一类,II,III,IV,V,VI,分别,代表250(20.4%;ROM4.4%),546(44.5%;ROM3.8%),96(7.8%;ROM20.8%),231(18.8%;ROM15.2%),62(5.1%;ROM72.6%),41例(3.3%;ROM90.2%)患者。总体ROM为13.8%。阴性预测值(NPV)为96.2%。总体特异性为64.2%,阳性预测值(PPV)为31.9%。诊断准确率为67.8%。与国际数据库(CESQIP,EUROCRINE,和UKRTS),在这项研究中,贝塞斯达IV类的ROM似乎较低(15.2vs.26.7%,p=0.612)。
结论:尽管在许多研究中得到了验证,根据Bethesda分类的术前FNA细胞学分类的ROM可能因手术中心和国家而异,因为本研究显示较高的NPV和较低的PPV。
The
Bethesda System for Reporting Thyroid Cytopathology is a commonly used classification for fine needle aspiration (FNA) cytology of suspicious thyroid nodules. The risk of malignancy (ROM) for each category has recently been analyzed in three international databases. This paper compares the diagnostic performance of the
Bethesda classification in a high-volume referral center in Belgium.
All consecutive thyroid procedures were registered in a prospective database from January 2010 till August 2022. Patient and surgical characteristics, preoperative
Bethesda categories, and postoperative pathology results were analyzed.
Out of 2219 consecutive thyroid procedures, 1226 patients underwent preoperative FNA. Papillary thyroid cancer was the most prevalent malignancy (N = 119, 70.4%), followed by follicular (N = 17, 10.1%) and medullary thyroid cancer (N = 15, 8.9%). Micropapillary thyroid cancer was incidentally found in 46 (3.8%) patients.
Bethesda categories I, II, III, IV, V, and VI, respectively, represented 250 (20.4%; ROM 4.4%), 546 (44.5%; ROM 3.8%), 96 (7.8%; ROM 20.8%), 231 (18.8%; ROM 15.2%), 62 (5.1%; ROM 72.6%), and 41 (3.3%; ROM 90.2%) patients. Overall ROM was 13.8%. An negative predictive value (NPV) of 96.2% was found. Overall specificity was 64.2% with a positive predictive value (PPV) of 31.9%. Diagnostic accuracy was 67.8%. Compared to international databases (CESQIP, EUROCRINE, and UKRETS), ROM in this study appeared lower for Bethesda category IV (15.2 vs. 26.7% and p = 0.612).
Despite being validated in numerous studies, ROM based on preoperative FNA cytology classified according to the
Bethesda classification may vary among surgical centers and countries as this study reveals a higher NPV and lower PPV.