BackgroundThe Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) recommends an upper limit of 10% for atypia of undetermined significance (AUS). Recent data suggest that this category might be overused when the rate of cases with molecular positive results is low. As a quality metric, the AUS and positive call rates for this facility’s cytology laboratory and each cytopathologist (CP) were calculated.MethodsA retrospective analysis of all thyroid cytology cases in a 4.5‐year period was performed. Cases were stratified by TBSRTC, and molecular testing results were collected for indeterminate categories. The AUS rate was calculated for each CP and the laboratory. The molecular positive call rate (PCR) was calculated with and without the addition of currently negative to the positive results obtained from the ThyroSeq report.ResultsA total of 7535 cases were classified as nondiagnostic, 7.6%; benign, 69%; AUS, 17.5%; follicular neoplasm/suspicious for follicular neoplasm, 1.4%; suspicious for malignancy, 0.7%; and malignant, 3.8%. The AUS rate for each CP ranged from 9.9% to 36.8%. The overall PCR was 24% (range, 13%–35.6% per CP). When including cases with currently negative results, the PCR increased to 35.5% for the cytology laboratory (range, 13%–42.6% per CP). Comparison analysis indicates a combination of overcalling benign cases and, less frequently, undercalling of higher TBSRTC category cases.ConclusionsThe AUS rate in the context of PCR is a useful metric to assess cytology laboratory and cytopathologists’ performance. Continuous feedback on this metric could help improve the overall quality of reporting thyroid cytology.

中文翻译：

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意义未定的异型性和 ThyroSeq v3 阳性检出率作为细胞学实验室性能的质量控制指标

背景贝塞斯达甲状腺细胞病理学报告系统 (TBSRTC) 建议意义未明的异型性 (AUS) 的上限为 10%。最近的数据表明，当分子阳性结果的病例率较低时，这一类别可能会被过度使用。作为质量指标，计算了该机构细胞学实验室和每位细胞病理学家 (CP) 的 AUS 和阳性检出率。方法对 4.5 年期间的所有甲状腺细胞学病例进行回顾性分析。 TBSRTC 对病例进行分层，并收集不确定类别的分子检测结果。计算每个 CP 和实验室的 AUS 率。在 ThyroSeq 报告中获得的阳性结果中添加或不添加当前阴性结果的情况下，计算分子阳性检出率 (PCR)。结果 共有 7535 例病例被分类为非诊断，占 7.6%；良性，69%；澳大利亚，17.5%；滤泡性肿瘤/可疑滤泡性肿瘤，1.4%；可疑恶性肿瘤，0.7%；恶性，3.8%。每个 CP 的 AUS 率范围为 9.9% 至 36.8%。总体 PCR 为 24%（范围为每个 CP 13%–35.6%）。当包括当前结果为阴性的病例时，细胞学实验室的 PCR 增加到 35.5%（范围为每个 CP 13%–42.6%）。比较分析表明，高估良性病例和低估较高 TBSRTC 类别病例（不太常见）的组合。结论 PCR 背景下的 AUS 率是评估细胞学实验室和细胞病理学家表现的有用指标。对该指标的持续反馈有助于提高甲状腺细胞学报告的整体质量。