NIFTP时代甲状腺细针穿刺细胞学检查2 838例回顾性研究

Thyroid cytopathology with fine needle aspiration in the era of NIFTP： A retrospective analysis of 2 838 cases

摘要:

目的：分析新版甲状腺FNA细胞学Bethesda诊断系统（The Bethesda System for Reporting Thyroid Cytopathology，TB－SRTC）对我院甲状腺FNA诊断的影响。方法：对我院2015年1月至2017年4月间甲状腺FNA细胞学病例共2 838例及手术后病理进行回顾性分析。结果：2 838例甲状腺FNA标本中含101例标本不满意；1 268例良性病变；195例AUS/FLUS；5例滤泡型肿瘤/可疑滤泡型肿瘤；401例可疑恶性，其中有2例病例诊断为“可疑恶性，不除外具有乳头状核特点的非浸润性甲状腺滤泡性肿瘤（non-invasive follicular thyroid neoplasm with papillary like nuclear features，NIFTP）；868例恶性病例，共791例实施手术治疗，结果表明6个诊断类别中恶性风险（risk of malignancy，ROM）分别为0.0%、34.4%、71.4%、66.7%、69.0%和97.0%。1例细胞学诊断为滤泡性肿瘤/可疑滤泡性肿瘤术后证实为恶性潜能未定的高分化肿瘤。2例NIFTP均经手术证实。3例细胞学诊断为恶性的病例，术后证实为透明变梁状肿瘤。结论：我院甲状腺交界性肿瘤在甲状腺细胞学诊断中发生率低，根据新版Bethesda诊断系统，主要归类为滤泡性肿瘤/可疑滤泡性肿瘤、可疑恶性、恶性3组病变。以滤泡性结构或实性结构为主，伴有或者不伴有乳头状癌细胞核特点，实践中应避免过诊。

Abstract:

Objective：To investigate the role of the new Bethesda System for Reporting Thyroid Cytopathology（TBSRTC） in the diag－nosis of thyroid disease using fine needle aspiration（FNA）. Methods：A retrospective analysis was performed for the data on thyroid FNA cytopathology and postoperative pathology of 2 838 patients treated in our hospital from January 2015 to April 2017. Results：Among the 2838 thyroid FNA specimens，101 were considered unsatisfactory；1 268 were benign lesions；195 were evaluated as atypia of undetermined significance/follicular lesion of undetermined significance；5 were follicular tumor/suspected follicular tumor；401 were suspected malignancies，among which 2 were diagnosed with non-invasive follicular thyroid neoplasm with papillary-like nuclear features（NIFTP）；868 were malignant lesions. A total of 791 patients underwent surgical treatment，and the results showed that the risk of malignancy in the six categories was 0%，34.4%，71.4%，66.7%，69%，and 97%，respectively. One case of follicular tumor/suspected follicular tumor diagnosed by cytopathology was confirmed to be well-differentiated tumor of uncertain malignant potential by postop－erative pathology. Two cases of NIFTP were confirmed by surgery and 3 cases of malignancies diagnosed by cytopathology were proved to be hyalinizing trabecular tumor by postoperative pathology. Conclusion：Thyroid cytopathology reveals a low incidence rate of bor－derline thyroid tumors，and according to the new TBSRTC system，such tumors are mainly classified into follicular tumor/suspected follicular tumor，suspected malignancies，and malignancies. These tumors often have a follicular or solid structure，with or without papillary-like nuclear features，and overdiagnosis should be avoided in clinical practice.