Does the Diagnostic Performance of the Pathologist on the Indeterminate Categories of the Bethesda System for Reporting Thyroid Cytopathology Vary between Pediatric and Adult Patients?

IF 1.6 4区 医学 Q3 PATHOLOGY
Acta Cytologica Pub Date : 2024-01-01 Epub Date: 2024-10-14 DOI:10.1159/000541996
Sevgen Önder, Olcay Kurtulan, Cenk Sokmensuer, Gaye Guler, Diclehan Orhan
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Abstract

Introduction: The objectives of this study were to investigate the variation in the use of indeterminate categories of The Bethesda System for reporting thyroid cytopathology across age groups, particularly focusing on atypia of undetermined significance (AUS) category, and discern the potential role of a bias in pathologist's interpretation when dealing with pediatric patients.

Materials and methods: To highlight a more refined diagnostic pattern, thyroid fine-needle aspirations reported by a single pathologist over a span of 10 years enrolled to the study. A total of 8,827 cases from patients aged between 2 and 89 were categorized for each decades of ages. For the AUS category, AUS to malignant (AUS:M) ratio was calculated, and variations in distinct age groups and across the years were noted.

Results: The rate of indeterminate categories was 19% for the pediatric cases and 11% for the adults. When compared to adults, AUS diagnosis was more common in pediatric patients (14% vs. 9%), with rates of malignancy (ROMs) 54% and 45%, respectively. The AUS:M ratio during the study period ranged between 0.5 and 2.3 (mean 1.4). AUS:M ratio was highest in children below the age 11. Among AUS subtypes, AUS-nuclear predominated in both age groups, and papillary thyroid carcinoma emerged as the most common malignancy after resection. Follicular neoplasia category was higher in pediatric patients than in adults (4% vs. 1%), with similar ROMs (29% vs. 32%).

Conclusion: Indeterminate cytology diagnosis and subsequent ROM is higher in pediatric patients, which might be attributable to a slightly higher use of AUS diagnosis in the youngest children.

病理学家对贝塞斯达甲状腺细胞病理报告系统中不确定类别的诊断结果在儿童患者和成人患者之间是否存在差异?
简介本研究的目的是调查贝塞斯达系统(The Bethesda System)在不同年龄组甲状腺细胞病理学报告中使用的不确定类别的差异,尤其侧重于 "意义未定的不典型性(AUS)"类别,并辨别病理学家在对儿科患者进行拨号时的解释偏差的潜在作用:为了突出更精细的诊断模式,研究选取了一位病理学家10年来的甲状腺细针穿刺报告。共有8827例来自2至89岁患者的甲状腺细针穿刺病例被按年龄段进行了分类。对于 AUS 类别,计算了 AUS 与恶性(AUS:M)的比率,并注意到不同年龄组和不同年份的差异:结果:儿科病例的未确定类别率为 19%,成人为 11%。与成人相比,AUS诊断在儿科患者中更为常见(14%对9%),恶性肿瘤率(ROM)分别为54%和45%。研究期间的 AUS:M 比率介于 0.5 和 2.3 之间(平均为 1.4)。11岁以下儿童的AUS:M比率最高。在AUS亚型中,AUS-核型在两个年龄组中均占多数,甲状腺乳头状癌是切除后最常见的恶性肿瘤。儿童患者中滤泡性肿瘤的比例高于成人(4%对1%),ROM相似(29%对32%):结论:儿童患者的细胞学诊断不确定率和随后的ROM较高,这可能是因为年龄最小的儿童使用AUS诊断的比例略高。
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来源期刊
Acta Cytologica
Acta Cytologica 生物-病理学
CiteScore
3.70
自引率
11.10%
发文量
46
审稿时长
4-8 weeks
期刊介绍: With articles offering an excellent balance between clinical cytology and cytopathology, ''Acta Cytologica'' fosters the understanding of the pathogenetic mechanisms behind cytomorphology and thus facilitates the translation of frontline research into clinical practice. As the official journal of the International Academy of Cytology and affiliated to over 50 national cytology societies around the world, ''Acta Cytologica'' evaluates new and existing diagnostic applications of scientific advances as well as their clinical correlations. Original papers, review articles, meta-analyses, novel insights from clinical practice, and letters to the editor cover topics from diagnostic cytopathology, gynecologic and non-gynecologic cytopathology to fine needle aspiration, molecular techniques and their diagnostic applications. As the perfect reference for practical use, ''Acta Cytologica'' addresses a multidisciplinary audience practicing clinical cytopathology, cell biology, oncology, interventional radiology, otorhinolaryngology, gastroenterology, urology, pulmonology and preventive medicine.
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