- 期刊
超音波檢查與現代細胞學分類（TBSRTC）於甲狀腺結節之診斷
Ultrasound Examination and the Bethesda System for Reporting Thyroid Cytopathology in the Diagnosis of Thyroid Nodules
摘要
背景：本研究目的在比較甲狀腺超音波檢查及現代細胞學TBSRTC分類系統與最終病理的相關性，以及討論如何依照甲狀腺超音波檢查及現代細胞學TBSRTC分類系統處置甲狀腺結節。方法：回顧從2011年7月到2013年7月在亞東醫院耳鼻喉科，約兩年期間進行之甲狀腺手術，當甲狀腺結節手術前有進行超音波導引甲狀腺腫瘤穿刺切片檢查才納入分析，共有102例。收集病人的年齡、性別、甲狀腺結節超音波檢查結果、超音波導引細針穿刺細胞學檢查以現代細胞學TBSRTC分類，與病理學檢查結果比較。結果：在超音波檢查方面，發現結節邊緣（margin）不清楚、低超音波回音性（hypo-echogenicity）、固態實心為主的超音波結構（echo-structure）、鈣化（calcification）及前後徑／側徑值大於1（taller than wide, AP/TR ＞ 1）等超音波特點與甲狀腺結節的惡性有統計顯著差別（p ＜ 0.01）。現代細胞學TBSRTC分類系統I～VI的惡性比例分別是0%（0／5），14%（6／44），33%（3／9），33%（1／3），92%（12／13）及100%（28／28）。結節邊緣不清楚的超音波檢查特點有最好的敏感度診斷甲狀腺癌（84%），現代細胞學TBSRTC分類系統（V&VI）有較高的特異度（98.08%）、陽性預測值（97.56%）、陰性預測值（83.61%）及準確率（89.22%）診斷甲狀腺癌。結論：針對甲狀腺結節，醫師進行超音波檢查時，可以利用甲狀腺結節超音波特點，選擇較多異常特點的結節進行超音波導引下細針穿刺細胞學檢查。更可以參考超音波特點與現代細胞學TBSRTC報告分類系統進行甲狀腺結節後續的處置。
並列摘要
BACKGROUND: The purpose of this study was to compare relationships between thyroid ultrasound examinations, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), and final pathology reports. We also discuss the management of thyroid nodules based on the results of ultrasound analysis and the classes of the Bethesda System. METHODS: We conducted a retrospective study that included patients who received ultrasound-guided fine-needle aspiration before thyroid surgery between July 2011 and July 2013 in department of otolaryngology. For each patient, we collected information related to age and gender, as well as records for ultrasound examination of thyroid nodules, fine-needle aspiration (Bethesda System), and pathology reports. RESULTS: Ultrasound features of benign and malignant thyroid nodules with statistically significant differences (p ＜ 0.01) included thyroid nodule margins (normal or irregular), presence or absence of hypo-echogenicity, architecture (solid or follicular), degree of calcification, and shape (e.g. ＂taller than wide＂; AP/TR ＞ 1). The malignant proportions of thyroid nodule in TBSRTC classes I through VI were 0% (0/5), 14% (6/44), 33% (3/9), 33% (1/3), 92% (12/13), and 100% (28/28), respectively. Additionally, we found that thyroid nodule margins provide the best sensitivity in diagnosing thyroid cancer (84%), and classes V and VI of the TBSRTC classification system have higher specificity (98.08%), positive predictive value (PPV; 97.56%), negative predictive value (NPV; 83.61%) and overall accuracy (89.22%) in diagnosing thyroid cancer. CONCLUSIONS: More specific ultrasound features of thyroid nodules with fine needle aspiration under ultrasound guidance can be used to identify high-grade malignant nodules for treatment. Physicians can manage the nodules based on ultrasound features and cytopathological reports from the Bethesda system.