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首页> 外文期刊>Surgery >Classification and treatment of follicular thyroid neoplasms are discordant between and within medical specialties.
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Classification and treatment of follicular thyroid neoplasms are discordant between and within medical specialties.

机译：甲状腺滤泡性肿瘤的分类和治疗在医学专科之间和医学专科之间是不一致的。

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BACKGROUND: The histologic criteria to classify follicular thyroid neoplasms are controversial. Criteria used for diagnosis and treatment varies both within and between specialty groups. This discordance makes it difficult to compare disease and management practice. This is especially problematic in issues concerning reoperations and survival. To determine the degree of disparity, we surveyed 3 groups of specialists. METHODS: A questionnaire describing 10 histologic scenarios was sent to an equal number of thyroidologists, endocrine surgeons, and endocrine pathologists. Individuals were randomly selected from rosters of 3 corresponding societies. Each item asked for a rating of a diagnosis and treatment. Questionnaires were distributed and received by facsimile, and responses were kept confidential. The response rate was 60%. RESULTS: Responses were analyzed by nonparametric statistical tests. Two scenarios had significant disagreement among specialties in both diagnosis and treatment: one scenario involved the assessment of neoplasms with minimal capsular invasion; the other scenario involved Hurthle cell features. In both scenarios pathologists tended to be more conservative in assigning the term carcinoma and recommending total thyroidectomy. Significant disagreement within specialty groups was also noted. Two other scenarios dealt with the distinction between minimally and widely invasive carcinoma; significantly, pathologists viewed tumors as less invasive. CONCLUSIONS: This study indicates that much disparity exists among specialists in pathology, endocrinology, and surgery and among experts in each of these disciplines. It highlights that there is no uniform classification. If multicenter trials to evaluate treatment options are to occur, a universal classification must be accepted.
机译：背景：对滤泡性甲状腺肿瘤进行分类的组织学标准存在争议。在专业群体内部和之间，用于诊断和治疗的标准各不相同。这种不一致性使得很难比较疾病和管理实践。这在涉及再手术和生存的问题中尤其成问题。为了确定差异程度，我们调查了3组专家。方法：将描述10种组织学情况的调查表发送给了相同数量的甲状腺科医生，内分泌外科医生和内分泌病理学家。从3个相应社会的名单中随机选择个人。每个项目都要求对诊断和治疗进行评级。问卷通过传真分发和接收，答复保密。回应率为60％。结果：通过非参数统计检验对反应进行了分析。两种情况在诊断和治疗方面各专业之间存在重大分歧：一种情况涉及评估包膜浸润最少的肿瘤;其他场景涉及Hurthle单元功能。在这两种情况下，病理学家在分配术语“癌”和建议进行全甲状腺切除术方面都趋于保守。还注意到专业团体之间的重大分歧。另两种情况涉及微创和广泛浸润癌之间的区别。显然，病理学家认为肿瘤的浸润性较小。结论：这项研究表明，病理学，内分泌学和手术学专家之间以及这些学科的专家之间存在很大差距。它强调没有统一的分类。如果要进行多中心试验以评估治疗方案，则必须接受通用分类。

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