갑상샘 세침흡인세포검사에서 미결정 범주의 분석
The Analysis of Indeterminate Category in Thyroid Fine Needle Aspiration
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background : Descriptive diagnosis reports have been causing some problems in communication. Our institution decided to use the category diagnosis system since June, 2008. So we evaluated the effectiveness of this change. Methods : The category system is composed of unsatisfactory, suboptimal for diagnosis but suggestive of, most probably benign, indeterminate, suspicious for malignancy and malignancy. We evaluated 1,525 cases from June, 2008 to September, 2009. We analyzed 159 cases of the indeterminate category. Results : Among the 159 cases, 21 were re-aspirated and 63 underwent an operation. The diagnoses of the re-aspirated cases were 2 positive for malignancy, 5 indeterminate, 13 most probably benign, and 1 unsatisfactory. The surgical diagnoses were 39 malignancies, 2 follicular adenomas and 1 Hürthle cell adenoma, and 21 benign lesions. Re-aspiration for the indeterminate cases could help decide whether the lesions need to be operated or not at above 70%. The indeterminate category could predict the surgical diagnosis of the thyroid nodule with statistical significance when the subcategories were indicated (p < 0.001). Conclusions : The category diagnosis is replacing the descriptive diagnosis for the thyroid fine needle aspiration. The indeterminate category is useful and effective for making the decision to operate and especially when the indeterminate subcategories are used.
Abstract
Background : Descriptive diagnosis reports have been causing some problems in communication. Our institution decided to use the category diagnosis system since June, 2008. So we evaluated the effectiveness of this change. Methods : The category system is composed of unsatisfactory, suboptimal for diagnosis but suggestive of, most probably benign, indeterminate, suspicious for malignancy and malignancy. We evaluated 1,525 cases from June, 2008 to September, 2009. We analyzed 159 cases of the indeterminate category. Results : Among the 159 cases, 21 were re-aspirated and 63 underwent an operation. The diagnoses of the re-aspirated cases were 2 positive for malignancy, 5 indeterminate, 13 most probably benign, and 1 unsatisfactory. The surgical diagnoses were 39 malignancies, 2 follicular adenomas and 1 Hürthle cell adenoma, and 21 benign lesions. Re-aspiration for the indeterminate cases could help decide whether the lesions need to be operated or not at above 70%. The indeterminate category could predict the surgical diagnosis of the thyroid nodule with statistical significance when the subcategories were indicated (p < 0.001). Conclusions : The category diagnosis is replacing the descriptive diagnosis for the thyroid fine needle aspiration. The indeterminate category is useful and effective for making the decision to operate and especially when the indeterminate subcategories are used.
참고문헌 (30)
- "Guidelines of the Papanicolaou Society of Cytopathology for fineneedle aspiration procedure and reporting: the Papanicolaou Society of Cytopathology Task Force on Standards of Practice", Diagn Cytopathol, 17, pp.239~247 (1997)
- Sidawy MK, "Fine-needle aspiration of thyroid nodules:correlation between cytology and histology and evaluation of discrepant cases", Cancer, 81, pp.253~259 (1997)
- Poller DN, "Fine-needle aspiration of the thyroid", Cancer, 90, pp.239~244 (2000)
- Wang HH, "Reporting thyroid fine-needle aspiration:literature review and a proposal", Diagn Cytopathol, 34, pp.67~76 (2006)
- "NCI Thyroid Fine Needle Aspiration (FNA) State of the Science Conference and web site"[URL]
- Gharib H, "Fine-needle aspiration biopsy of thyroid nodules:advantages,limitations,and effect", Mayo Clin Proc, 69, pp.44~49 (1994)
- Amrikachi M, "Accuracy of fineneedle aspiration of thyroid", Arch Pathol Lab Med, 125, pp.484~488 (2001)
- Hamberger B, "Fine-needle aspiration biopsy of thyroid nodules:impact on thyroid practice and cost of care", Am J Med, 73, pp.381~384 (1982)
- Yassa L, "Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation", Cancer, 111, pp.508~516 (2007)
- Oertel YC, "Cytopathology reports from fine needle aspirations of the thyroid gland:can they be improved?", Thyroid, 17, pp.33~35 (2007)
- Cooper DS, "Management guidelines for patients with thyroid nodules and differentiated thyroid cancer", Thyroid, 16, pp.109~142 (2006)
- Gharib H, "American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules", Endocr Pract, 12, pp.63~102 (2006)
- Baloch ZW, "Diagnostic terminology and morphologic criteria for cytologic diagnosis of thyroid lesions:a synopsis of the National Cancer Institute Thyroid Fine-Needle Aspiration State of the Science Conference", Diagn Cytopathol, 36, pp.425~437 (2008)
- Cibas ES, "The Bethesda system for reporting thyroid cytopathology", Thyroid, 19, pp.1159~1165 (2009)
- Ali SZ, "The Bethesda system for reporting thyroid cytopathology" (2010), Springer
- Pepper GM, "Fine-needle aspiration biopsy of the thyroid nodule:results of a start-up project in a general teaching hospital setting", Arch Intern Med, 149, pp.594~596 (1989)
- Ca@p J, "Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid:clinical point of view", Clin Endocrinol(Oxf), 51, pp.509~515 (1999)
- Ceresini G, "Ultrasound-guided fine-needle capillary biopsy of thyroid nodules,coupled with on-site cytologic review,improves results", Thyroid, 14, pp.385~389 (2004)
- Gagneten CB, "The role of fine needle aspiration biopsy cytology in the evaluation of the clinically solitary thyroid nodule", Acta Cytol, 31, pp.595~598 (1987)
- Prinz RA, "Fine needle aspiration biopsy of thyroid nodules", Ann Surg, 198, pp.70~73 (1983)
- Klemi PJ, "Fine needle aspiration biopsy in the diagnosis of thyroid nodules", Acta Cytol, 35, pp.434~438 (1991)
- Hall TL, "Sources of diagnostic error in fine needle aspiration of the thyroid", Cancer, 63, pp.718~725 (1989)
- Akerman M, "Sensitivity and specificity of fine needle aspiration cytology in the diagnosis of tumors of the thyroid gland", Acta Cytol, 29, pp.850~855 (1985)
- Baloch ZW, "Ultrasound-guided fine-needle aspiration biopsy of the thyroid:role of onsite assessment and multiple cytologic preparations", Diagn Cytopathol, 23, pp.425~429 (2000)
- Cochand-Priollet B, "The diagnostic value of fine-needle aspiration biopsy under ultrasonography in nonfunctional thyroid nodules:a prospective study comparing cytologic and histologic findings", Am J Med, 97, pp.152~157 (1994)
- Renshaw AA, "Accuracy of thyroid fine-needle aspiration using receiver operator characteristic curves", Am J Clin Pathol, 116, pp.477~482 (2001)
- Hamburger JI, "Diagnosis of thyroid nodules by fine needle biopsy:use and abuse", J Clin Endocrinol Metab, 79, pp.335~339 (1994)
- Shi Y, "Thyroid fine-needle aspiration with atypia of undetermined significance:a necessary or optional category?", Cancer Cytopathol, 117, pp.298~304 (2009)
- Sclabas GM, "Fine-needle aspiration of the thyroid and correlation with histopathology in a contemporary series of 240 patients", Am J Surg, 186, pp.702~709 (2003)
- Hong EK, "A national study on biopsy-confirmed thyroid diseases among Koreans:an analysis of 7,758 cases", J Korean Med Sci, 5, pp.1~12 (1990)