356例甲状腺Bethesda Ⅲ类结节的细胞病理学诊断分析  

Cytopathological diagnosis of Bethesda Ⅲ thyroid nodules:a report of 356 cases

作　　者：刘军[1] 余小蒙[2] 李太利 陈燕[3] 尹为华[1] LIU Jun;YU Xiaomeng;LI Taili;CHEN Yan;YIN Weihua(Department of Pathology,Peking University Shenzhen Hospital,Shenzhen 518036,China;Department of Pathology,Beijing Friendship Hospital,Beijing 100050,China;Department of Ultrasound,Peking University Shenzhen Hospital,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院病理科,深圳518036 [2]北京友谊医院病理科,北京100050 [3]北京大学深圳医院超声科,深圳518036

出　　处：《广州医药》2021年第6期14-17,共4页Guangzhou Medical Journal

摘　　要：目的探讨甲状腺BethesdaⅢ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法收集356例BethesdaⅢ结节患者,对其诊断原因,ROM及亚分类进行总结分析。结果在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),BethesdaⅢ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。BethesdaⅢ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P<0.05)。结论BethesdaⅢ类的诊断具有一定的主观性和经验性,而对BethesdaⅢ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。Objective To investigate the diagnostic causes of Bethesda Ⅲ(AUS/FLUS)thyroid nodules and the value of subcategories in predicting risk of malignancy(ROM)of thyroid nodules.Methods The data of 356 cases of Bethesda Ⅲ nodules were collected,and the causes,ROM and subcategories were summarized.Results In 97 resected specimens,72 were diagnosed as papillary thyroid carcinoma(PTC),and the ROM of Bethesda Ⅲ was 74.2%.The main factors affecting the diagnosis of PTC were small lesions,few puncture cells,atypical nuclear features and lack of papillary structure.Secondary factors included significant interstitial fibrosis or calcification,unqualified smear,improper fixation,poor staining and lack of cytological diagnosis experience.According to the subcategories of Bethesda Ⅲ,132 cases were included in low-risk group,nodules of 12 cases in the group were resected,which ROM was 8.3%;122 cases were included in high-risk group,nodules of 70 cases were resected,which ROM was 92.9%;102 cases were included in middle-risk group,nodules of 15 cases were resected,which ROM was 40.0%.The differences between high-risk group and low/medium-risk group were statistically significant(P<0.05).Conclusion The diagnosis of BethesdaⅢis subjective and empirical in some degree,and the risk related subcategories of Bethesda Ⅲ nodules is helpful to achieve better ROM stratification and improve the clinical management of the disease.

关 键 词：甲状腺 细针吸取细胞学 BethesdaⅢ类 亚分类 甲状腺乳头状癌 

分 类 号：R736.1[医药卫生—肿瘤]