Bethesda Classification에 의거한 갑상선 세침흡인 검사 결과 분석 및 Atypical Cells of Undetermined Significance의 임상적 의의에 대한 고찰
Analysis of Cytopathology of Fine Needle Aspiration Biopsy of the Thyroid according to Bethesda Classification and Clinical Implication of Atypical Cells of Undetermined Significance
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Purpose: The frequency of diagnosis of each nodule category under the Bethesda classification was studied, and the differences in the results between cytopathologic and histopathologic analyses of same patients were assessed. Special attention was paid to the atypical cells of undetermined significance (ACUS), which is an intermediate category. The histopathology of ACUS specimens was confirmed to examine the clinical implication. Methods: Patients (n=417) who underwent thyroid ultrasonography and fine needle aspiration of the thyroid since the application of Bethesda classification (November 2009 to August 2010) in this institution was enrolled in the study. Results: According to the Bethesda criteria, of the 640 nodules there were 56 cases (8.8%) of ACUS, 14 cases (2.2%) of follicular neoplasm, 13 cases (2.0%) were suspicious for malignancy, and 37 cases (5.8%) were positive of malignancy. A total of 102 surgically-excised specimens were obtained, of which 40 specimens were previously categorized cytopathologically as ACUS. Of these 40 specimens, 16 cases (40%) were found to be malignant. Conclusion: A precise understanding of each diagnostic category seems to be necessary, which may help with treatment of patients with thyroid mass. This is especially true for ACUS, which was previously understood as an intermediate specimen, but which is actually a heterogeneous mix of benign specimen, benign specimen with various atypia, and malignancy. In case of ACUS, an extensive and accurate diagnostic approach utilizing various examination methods may be beneficial for the patient treatment. (Korean J Endocrine Surg 2010;10:240-244)
Abstract
Purpose: The frequency of diagnosis of each nodule category under the Bethesda classification was studied, and the differences in the results between cytopathologic and histopathologic analyses of same patients were assessed. Special attention was paid to the atypical cells of undetermined significance (ACUS), which is an intermediate category. The histopathology of ACUS specimens was confirmed to examine the clinical implication. Methods: Patients (n=417) who underwent thyroid ultrasonography and fine needle aspiration of the thyroid since the application of Bethesda classification (November 2009 to August 2010) in this institution was enrolled in the study. Results: According to the Bethesda criteria, of the 640 nodules there were 56 cases (8.8%) of ACUS, 14 cases (2.2%) of follicular neoplasm, 13 cases (2.0%) were suspicious for malignancy, and 37 cases (5.8%) were positive of malignancy. A total of 102 surgically-excised specimens were obtained, of which 40 specimens were previously categorized cytopathologically as ACUS. Of these 40 specimens, 16 cases (40%) were found to be malignant. Conclusion: A precise understanding of each diagnostic category seems to be necessary, which may help with treatment of patients with thyroid mass. This is especially true for ACUS, which was previously understood as an intermediate specimen, but which is actually a heterogeneous mix of benign specimen, benign specimen with various atypia, and malignancy. In case of ACUS, an extensive and accurate diagnostic approach utilizing various examination methods may be beneficial for the patient treatment. (Korean J Endocrine Surg 2010;10:240-244)
참고문헌 (24)
- Baek JB, "The correlation between the fine needle aspiration cytology and histology of patients who have undergone thyroidectomy", Endocrine, 9, pp.223~227 (2009)
- Vander JB, "The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy", Ann Intern Med, 69, pp.537~540 (1968)
- Rojeski MT, "Nodular thyroid disease. Evaluation and management", N Engl J Med, 313, pp.428~436 (1985)
- Davies L, "Increasing incidence of thyroid cancer in the United States, 1973-2002", JAMA, 295, pp.2164~2167 (2006)
- Tan GH, "Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging", Ann Intern Med, 126, pp.226~231 (1997)
- Yang J, "Fine-needle aspiration of thyroid nodules: a study of 4703 patients with histologic and clinical correlations", Cancer, 111, pp.306~315 (2007)
- Cooper DS, "Management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 16, pp.109~142 (2006)
- Baloch ZW, "The National Cancer Institute Thyroid fine needle aspiration state of the science conference: a summation", Cytojournal, 5, pp.6~ (2008)
- Redman R, "Perceptions of diagnostic terminology and cytopathologic reporting of fine-needle aspiration biopsies of thyroid nodules: a survey of clinicians and pathologists", Thyroid, 16, pp.1003~1008 (2006)
- Eedes CR, "Cost-effectiveness of immediate specimen adequacy assessment of thyroid fine-needle aspirations", Am J Clin Pathol, 121, pp.64~69 (2004)
- Kelly NP, "Specimen adequacy and diagnostic specificity of ultrasound-guided fine needle aspirations of nonpalpable thyroid nodules", Diagn Cytopathol, 34, pp.188~190 (2006)
- Cibas ES, "The bethesda system for reporting thyroid cytopathology", Am J Clin Pathol, 132, pp.658~665 (2009)
- Amrikachi M, "Accuracy of fine-needle aspiration of thyroid", Arch Pathol Lab Med, 125, pp.484~488 (2001)
- Theoharis CG, "The Bethesda thyroid fine-needle aspiration classification system: year 1 at an academic institution", Thyroid, 19, pp.1215~1223 (2009)
- Ravetto C, "Usefulness of fine-needle aspiration in the diagnosis of thyroid carcinoma: a retrospective study in 37,895 patients", Cancer, 90, pp.357~363 (2000)
- Renshaw AA, "Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves", Am J Clin Pathol, 116, pp.477~482 (2001)
- Yassa L, "Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation", Cancer, 111, pp.508~516 (2007)
- 은영규, "갑상선 결절에서 세침흡인검사: Bethesda Classification의 임상적 적용", 대한이비인후과학회지 두경부외과학, 53(7), pp.436~440 (2010), 대한이비인후과학회
- Layfield LJ, "Implications of the proposed thyroid fine-needle aspiration category of "follicular lesion of undetermined significance": A five-year multi-institutional analysis", Diagn Cytopathol, 37, pp.710~714 (2009)
- Alexander EK, "Assessment of nondiagnostic ultrasound- guided fine needle aspirations of thyroid nodules", J Clin Endocrinol Metab, 87, pp.4924~4927 (2002)
- Khoo ML, "Thyroid calcification and its association with thyroid carcinoma", Head Neck, 24, pp.651~655 (2002)
- Gharib H, "Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11,000 biopsies", Clin Lab Med, 13, pp.699~709 (1993)
- Pitman MB, "Techniques for thyroid FNA: a synopsis of the national cancer institute thyroid fine-needle aspiration state of the science conference", Diagn Cytopathol, 36, pp.407~424 (2008)
- Su-kyoung Jeh, "Evaluating the Degree of Conformity of Papillary Carcinoma and Follicular Carcinoma to the Reported Ultrasonographic Findings of Malignant Thyroid Tumor", Korean Journal of Radiology, 8(3), pp.192~197 (2007), 대한영상의학회