甲状腺细胞病理学Bethesda报告系统:单中心2257个甲状腺结节诊断的应用体会  

The Bethesda System for Reporting Thyroid Cytopathology:A Single-Center Experience of 2257 Thyroid Nodules

作　　者：孙映荷[1] 刘念[2] 姜勇[2] 苏学英[2] 龚日祥[1] 李志辉[1] 魏涛[1] 邹秀和[1] 刘枫[1] 朱精强[1] 

机构地区：[1]四川大学华西医院甲状腺乳腺外科,四川成都610041 [2]四川大学华西医院病理科,四川成都610041

出　　处：《中国普外基础与临床杂志》2014年第9期1076-1080,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省科技支撑计划项目(项目编号:2013SZ0093);四川省卫生厅科研课题(项目编号:120203)~~

摘　　要：目的总结应用甲状腺细胞病理学Bethesda报告系统(The Bethesda System for Reporting Thyroid Cytopathology,TBSRTC)进行甲状腺细胞学诊断的经验,并对TBSRTC的诊断价值进行评价。方法收集四川大学华西医院病理科2010年1月至2012年12月期间完成甲状腺细胞学TBSRTC分级诊断的2 257个甲状腺结节的病理资料,并计算TBSRTC诊断甲状腺恶性结节的灵敏度、特异度、准确率等诊断价值指标。结果 2 257个甲状腺结节中含Ⅰ级442个,占19.6%;Ⅱ级1 184个,占52.4%;Ⅲ级216个,占9.6%;Ⅳ级38个,占1.7%;Ⅴ级172个,占7.6%;Ⅵ级205个,占9.1%。以TBSRTCⅡ级为诊断良恶性的界点,若不纳入Ⅲ级结节,则TBSRTC分级的灵敏度为93.7%(236/252),特异度为86.6%(323/373),准确率为89.4%(559/625);若将Ⅲ级结节纳入分析,则TBSRTC分级的灵敏度为94.3%(267/283),特异度为74.9%(323/431),准确率为82.6%(590/714)。结论 TBSRTC分级在笔者所在医院的应用实践表明其真实性较高,是准确和可靠的甲状腺细胞学分类诊断系统。Objective To report our experience in using The Bethesda System for Reporting Thyroid Cytopathology（TBSRTC）, and to investigate the diagnostic value of the system based on the cytologic-histologic result. Methods Pathological data of 2 257 thyroid nodules classified by TBSRTC which were obtained from the Department of Pathology of West China Hospital between Jan.2010 to Dec.2012 were collected and analyzed, to investigate the diagnostic evaluation indicators, such as the sensitivity, specificity, and diagnostic accuracy of the system based on the cytologic-histologic result. Results Of the 2 257 thyroid nodules, 442（19.6%） were diagnosed as categoryⅠ,1 184（52.4%） were diagnosed as category Ⅱ, 216（9.6%） were diagnosed as category Ⅲ, 38（1.7%） were diagnosed as category Ⅳ, 172（7.6%） were diagnosed as category Ⅴ, 205（9.1%） were diagnosed as category Ⅵ. Using TBSRTC category Ⅱ as the boundary point of diagnosing benign and malignant diseases, the sensitivity, specificity, and diagnostic accuracy were 93.7%（236/252）, 86.6%（323/373）, and 89.4%（559/625）respectively, while category Ⅲwas excluded from analysis. When including category Ⅲ into analysis, the sensitivity, specificity, and diagnostic accuracywere 94.3%（267/283）, 74.9%（323/431）, and 82.6%（590/714）respectively. Conclusions The validity of TBSRTC was high at our institution. TBSRTC has proven to be an accurate and reliable approach for the diagnosis of thyroid nodules.

关 键 词：甲状腺细胞病理学Bethesda报告系统 细胞学诊断 细针穿刺 甲状腺结节 

分 类 号：R446.8[医药卫生—诊断学] R581.04[医药卫生—临床医学]