Bethesda细胞病理报告系统在甲状腺细针穿刺中的应用  

Application of Bethesda system for reporting cytology in thyroid fine needle aspiration

作　　者：蔡赟[1] 陈欢欢[1] 王知笑[1] 戎荣[2] 吴云松[2] 崔岱[1] 蒋琳[1] 魏玲[1] 段宇[1] 杨涛[1] 刘晓云[1] 

机构地区：[1]南京医科大学第一附属医院内分泌科,江苏南京210029 [2]南京医科大学第一附属医院病理科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2015年第12期1718-1721,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(30971405;81270897);国家临床重点专科培育项目;江苏高校优势学科建设工程资助项目

摘　　要：目的 :将Bethesda细胞病理报告系统(TBS)应用于甲状腺细针穿刺(FNA)细胞病理读片,提高FNA细胞病理诊断水平。方法:收集1 705份FNA细胞病理样本,同时对比分析其中66例接受外科手术的组织病理样本。结果:1 705份中病理片归为"无诊断价值"(N)、"良性"(B)、"不确定价值的不典型增生"(AUS)、"滤泡性肿瘤"(FN)、"怀疑恶性"(S)和"恶性"(M)的分别有295(17.30%)、1 291(75.72%)、30(1.76%)、19(1.11%)、36(2.11%)和34(1.99%)例。总体阳性细胞率82.70%。对66例同时接受FNA和手术的患者细胞和组织病理对比分析得出,前2类总体恶性可能性仅为11.11%,而后4类总体恶性可能性为63.33%,较前者显著升高(P<0.01)。FNA对恶性或癌前病变诊断的敏感性为82.61%,特异性为74.42%,阳性预测值为63.33%,阴性预测值为88.89%,假阳性率为25.58%,假阴性率为17.39%。结论:TBS类别中AUS、FN、S和M类恶性风险较高,对于指导临床实践有重要价值。Objective：Application of the Bethesda system（TBS）for reporting thyroid cytology in fine needle aspiration（FNA）to improve the capability of cytopathological diagnosis. Methods：Totally 1 705 FNA cytopathological samples were analyzed from May2011 to Jun 2012. Sixty-six histological pathological samples from these patients were analyzed in the meantime. Results：According to TBS,1 705 FNA cytopathological samples were classified into six categories with 295（17.30%）as nondiagnostic（N）,1 291（75.72%）as benign（B）,30（1.76%）as atypia of undetermined significance（AUS）,19（1.11%）as follicular neoplasm（FN）,36（2.11%）as suspicious（S）and 34（1.99%）as malignant（M）. Total positive cell rate was 82.70%. It was concluded from the comparison of histopathological and cytopathological slides of 66 patients that the overall occurrence rate of malignancy was 11.11% in former two groups,which was significantly lower than that（63.33%） in latter four groups（P〈0.01）. The sensitivity,specificity,positive predictive value,negative predictive value,false positive rate and false negative rate for FNA in differentiation of benign and malignant lesions were calculated as 82.61%,74.42%,63.33%,88.89%,25.58% and 17.39%, respectively. Conclusion：TBS showed great importance in differentiation of benign and malignant thyroid lesions,with high probability of malignancy in AUS,FN,S and M groups.

关 键 词：Bethesda细胞病理报告系统 甲状腺细针穿刺 细胞病理 甲状腺结节 甲状腺囊性变 慢性淋巴细胞性甲状腺炎 亚急性甲状腺炎 

分 类 号：R581.2[医药卫生—内分泌] R581.3[医药卫生—内科学]