[Bethesda classification of fine needle punctures of the thyroid. Much ado about nothing really new?].
[Bethesda classification of fine needle punctures of the thyroid. Much ado about nothing really new?].
复制标题
[甲状腺细针穿刺的贝塞斯达分类。
DOI：
10.1007/s00292-012-1575-y
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
M. Tötsch
中科院分区：
文献类型：
--
作者：
R. Schäffer;K. Schmid;M. Tötsch
用于报告甲状腺细胞病理学的 Bethesda 系统于 2008 年发布（Baloch et al. 2008, Cytojournal 5:6；Baloch et al. 2008, Diagn Cytopathol 36:425-437），提供与临床数据密切相关的分类系统。其目的是确保术语充足且不存在理解错误的风险，就与细胞学诊断相关的治疗选择向临床医生提供建议，并促进国家和国际层面细胞学数据的比较。然而，主要由于美国的具体要求（医疗和法律），这种分类系统尚未在大多数欧洲国家得到充分认可。原因是多方面的： (a) 代表性材料的标准比常用的标准严格得多，在德国，结果会导致更多（不必要的）重新穿刺。 (b) 引入“意义不明的异型性或意义不明的滤泡病变”这一新的且相当异质的类别是否会导致归类为“滤泡瘤形成”的发现的大幅减少，仍然值得怀疑。此外，如果新的诊断类别与计算出的 5-15% 病例的恶性肿瘤风险相关，那么临床医生不太可能愿意接受推荐的再次穿刺保守方法。 (c) 迄今为止，尚未将分子标记的新进展整合到 Bethesda 系统中。因此，对于经验丰富的细胞学家来说，与目前使用的、已建立的和高度接受的分类系统相比，用于报告甲状腺细胞病理学的 Bethesda 系统提供的好处非常有限。然而，一个积极的论点仍然是，国际公认的分类系统可以提高国家和国际甲状腺研究结果的可比性。
The Bethesda system for reporting thyroid cytopathology was published in 2008 (Baloch et al. 2008, Cytojournal 5:6; Baloch et al. 2008, Diagn Cytopathol 36:425-437) offering a classification system which is closely related to clinical data. The aim was to ensure adequate terminology without risk of errors in understanding, to advise clinicians concerning therapeutic options in relationship to cytological diagnoses as well as to facilitate the comparison of cytology data at national and international levels. However, mainly due to specific US American (both medical and legal) demands, this classification system is not yet fully appreciated in most European countries. The reasons are various: (a) Criteria for representative material are much more restrictive than those commonly used and in Germany a higher number of (unnecessary) repunctures would be the consequence. (b) It remains doubtful whether the introduction of a new and rather heterogeneous category of "atypia of undetermined significance or follicular lesion of undetermined significance" would contribute to a substantial decrease of findings classified as "follicular neoplasia". Furthermore it is unlikely that clinicians would be willing to accept the recommended conservative approach with repuncture if a new diagnostic category is associated with a calculated risk of malignancy in 5-15% cases. (c) Until now an integration of new developments in molecular markers into the Bethesda system is missing. Thus, for experienced cytologists the Bethesda system for reporting thyroid cytopathology offers very limited benefits in comparison to the currently used, established and highly accepted classification systems. However, a positive argument remains the fact that an internationally accepted classification system may improve the comparability of the results of national and international studies on thyroid findings.