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首页> 外文期刊>Endocrinology, Diabetes & Metabolism >Yield and costs of molecular diagnostics on thyroid cytology slides in the Netherlands, adapting the Bethesda classification
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Yield and costs of molecular diagnostics on thyroid cytology slides in the Netherlands, adapting the Bethesda classification

机译：荷兰甲状腺细胞学幻灯片上分子诊断的产量和成本，适应贝塞斯达分类

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Objective To evaluate our institutional experience with molecular diagnostics (MD) on thyroid cytology smears, evaluate the costs and describe MD guided clinical management of indeterminate Bethesda III/V thyroid nodules. Methods We performed a retrospective review of 164 Bethesda III or V thyroid cytopathology reports subjected to MD from 2013 to 2020, that altered Bethesda classification or management. MD consisted of mutation and gene fusion analysis by next-generation sequencing (NGS) of morphologically analysed and selected cytological slides. Findings were modelled to nationwide data on Bethesda incidences from ‘the Dutch Pathology Registry’ PALGA, and costs were estimated. Results 82 of 164 cases received an upgrade in Bethesda class. Twenty cases changed from Bethesda III to IV/V, 62 from Bethesda III or V to VI, and 72?remained unaltered. We estimate net savings with implementing MD, by preventing 454 repeat cytology and 326 (diagnostic) hemithyroidectomies, to be at least 2?million Euro annually in the Netherlands. Per Bethesda III and V patient, net savings would be about 100 Euro and 4100 Euro, respectively. Conclusion NGS-based MD on nucleic acids extracted directly from cytology slides is a feasible and cost saving tool for personalized management in indeterminate Bethesda III/V thyroid cytology. Based on the interpretation of our retrospective data, we assume that this approach results in less disease burden for the patient, reduced surgical interventions and complication risks, reduced sick leave, among others. Further evaluation of structural implementation of the presented approach in routine thyroid Bethesda III/V cytology in a prospective setting is warranted.
机译：目的探讨我们对甲状腺细胞学涂片的分子诊断（MD）的制度经验，评价成本并描述了不确定的贝塞斯达III / V甲状腺结节的MD引导临床管理。方法对2013年至2020年的MD进行了164个Bethesda III或V甲状腺细胞病理学报告进行了回顾性审查，改变了Bethesda分类或管理。 MD由形态学分析和选定的细胞学载玻片的下一代测序（NGS）组成的突变和基因融合分析。调查结果被建模为“荷兰达人发病率”的全国数据，从“荷兰病理登记处”Palga，估计成本。结果在Bethesda课程中获得了164例的82例。二十例患者从贝塞斯达III转移到IV / v，62，从Bethesda III或V到VI，72？仍然没有改变。通过防止454重复细胞学和326（诊断）半胞嘧啶切除术，估计利用实施MD来估算净节约，每年在荷兰每年至少为2亿欧元。每贝塞斯达III和V病人，净储蓄将分别为100欧元和4100欧元。结论基于NGS的MD直接从细胞学载玻片提取的核酸是一种可行和成本节省的工具，用于在不确定的Bethesda III / V甲状腺细胞学中的个性化管理。根据我们回顾性数据的解释，假设这种方法导致患者的疾病较少，减少手术干预和并发症风险，减少病假等。需要进一步评估常规甲状腺乳酪乳酪III / V细胞学中所提出的方法的结构性实施的进一步评价在预期设定中。

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