滤泡细胞数量不足的甲状腺BethesdaⅠ/Ⅲ类结节恶性风险评估及原因分析  

Malignancy risk assessment and cause analysis of the Bethesda classⅠ/Ⅲcytology diagnosis due to insufficient cell volume in thyroid solid nodule

作　　者：虞红珍[1] 李明 解翔[2] 蓝晓锋[2] 徐天宇 黄山[1] 王弦[1] 冯振中 Yu Hongzhen;Li Ming;Xie Xiang;Lan Xiaofeng;Xu Tianyu;Huang Shan;Wang Xian;Feng Zhenzhong(Department of Pathology,the Second Affiliated Hospital of Anhui Medical University,Heifei 230601,China;Department of Ultrasonic Diagnosis,the Second Affiliated Hospital of Anhui Medical University,Heifei 230601,China)

机构地区：[1]安徽医科大学第二附属医院病理科,合肥230601 [2]安徽医科大学第二附属医院超声诊断科,合肥230601

出　　处：《临床与实验病理学杂志》2025年第1期44-50,共7页Chinese Journal of Clinical and Experimental Pathology

基　　金：安徽医科大学校科研基金(2021xkj174);安徽医科大学第二附属医院临床研究培育计划(2020LCYB14);省高校优秀青年人才支持计划项目(gxyq2021177)。

摘　　要：目的 探讨仅因滤泡细胞数量不足产生的甲状腺BethesdaⅠ、Ⅲ类诊断的发生率、恶性风险度(risk of malignancy, ROM);并从超声与组织结构角度分析其细胞量不足与结节结构特性的相关性。方法 收集甲状腺细针穿刺细胞学(fine needle aspiration cytology, FNAC)临床资料,复阅仅因滤泡细胞数量不足的BethesdaⅠ/Ⅲ类结节纳入分析,以BRAF V600E(+)或术后病理示甲状腺乳头状癌(papillary thyroid carcinoma, PTC)为恶性标准,统计此二类诊断的发生率、ROM值;并配对细胞量充足的BethesdaⅡ/Ⅵ类结节作为对照组资料,对比分析两组超声特征及病理组织图像。结果 甲状腺结节BethesdaⅠ/Ⅲ类病例数、发生率及ROM值分别为39/160、3.3%/13.5%、38.5%/59.4%。其中C-TIRADS≥4b结节发生率、ROM值(22.4%、67.6%)均高于C-TIRADS≤4a类结节(12.7%、39.8%),差异有统计学意义(P均<0.001)。与细胞量充足的BethesdaⅡ/Ⅵ类结节相比,BethesdaⅠ/Ⅲ类结节与结节过小(最大径<5 mm)、垂直位生长(纵横比≥1)及乏血供(无或少血流信号)呈显著相关性(r=0.131、-0.230、0.237,P=0.008、<0.001、<0.001);与病理组织结构的间质弥漫显著纤维化、实质/间质构成比低(约1∶1)显著相关性(r=-0.269、-0.396,P=0.019、<0.001)。结论 甲状腺BethesdaⅠ/Ⅲ类结节ROM值高,BRAF V600E检测是有效的补充辅助诊断工具;当结节过小、垂直位生长、乏血供更易出现细胞量不足的BethesdaⅠ/Ⅲ类诊断,推测与病理组织结构的间质弥漫显著纤维化而实质/间质构成比低相关。Purpose To investigate the incidence and risk of malignancy(ROM)of the Bethesda classⅠ/Ⅲdiagnosis of thyroid nodules due to insufficient number of follicular cells,and to analyze the correlation between their insufficient cell volume and the characteristics of the nodules themselves from the perspective of ultrasound and histology.Methods Clinical data were collected from fine needle aspiration cytology(FNAC)of the thyroid gland.Review and statistical analysis was performed on cases with the Bethesda classⅠ/Ⅲdiagnosis due to insufficient cell volume.The incidence and the ROM of Bethesda classⅠ/Ⅲdiagnosis were calculated.BRAF V600E(+)or postoperative pathological indicating papillary thyroid carcinoma(PTC)was used as the criterion for malignancy.Then,we matched the Bethesda classⅡ/Ⅵcases with sufficient cell volume as the control group.The ultrasound characteristics and histological images of the two groups were compared and analyzed in order to reveal the correlation between the insufficient amount of penetrating cells and the objective characteristics of the nodule itself.Results There were 39 solid thyroid nodules with the Bethesda class I diagnosis,with an incidence of 3.3%and a ROM of 38.5%,and 160 nodules with the Bethesda classⅢdiagnosis,with an incidence of 13.5%and a ROM of 59.4%.The incidence and ROM of nodules with C-TIRADS≥4b(22.4%,67.6%)were higher than those of C-TIRADS≤4a(12.7%,39.8%),and the differences were statistically significant(P<0.001).Compared to the Bethesda classⅡ/Ⅵnodules with sufficient cell volume,occurrence of the Bethesda classⅠ/Ⅲnodules were significantly correlated with small nodules(maximal diameter<5 mm),vertical growth(aspect ratio≥1)and poor blood supply(no or little blood flow signals)(r=0.131,-0.230,0.237,P=0.008,<0.001,<0.001).They were also significantly correlated with the pathologic histologic structure of diffuse significant fibrosis of the interstitium and low parenchyma/interstitium composition ratio(about 1∶1)(r=-0.269,-0.396,P=0.019,

关 键 词：滤泡细胞数量不足 恶性风险度 BethesdaⅠ/Ⅲ类诊断 C-TIRADS BRAF V600E 

分 类 号：R736.1[医药卫生—肿瘤]