甲状腺结节细针穿刺细胞学检查评估  

Fine-needle aspiration cytology of thyroid nodules： a clinical evaluation

作　　者：张永侠[1] 张彬[1] 张智慧[1] 郭会芹[1] 王勇[1] 徐震纲[1] 唐平章[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院肿瘤研究所头颈外科,100021

出　　处：《中华耳鼻咽喉头颈外科杂志》2011年第11期892-896,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨甲状腺细针穿刺细胞学（fine—needle aspiration，FNA）检查的临床价值。方法回顾性分析中国医学科学院肿瘤医院2005年10月至2011年1月行甲状腺细针穿刺的474例连续病例资料。B超引导下穿刺218例（46．0％），触诊穿刺256例（54．0％）。细胞学诊断结果分为六级：无法诊断、良性、不典型细胞、滤泡样肿瘤、可疑恶性及恶性。将其中157例手术患者术前细胞学诊断结果与术后组织病理学诊断结果进行比较。结果157例手术治疗患者中91例为恶性，术前FNA诊断为无法诊断2／7、良性16．7％（9／54）、不典型细胞3／9、滤泡样肿瘤1／3、可疑恶性83．3％（35／42）、恶性97．6％（41／42）。甲状腺细针穿刺鉴别甲状腺结节良恶性的敏感度为85．4％，特异度为86．9％。阳性预测值90．5％。结论甲状腺细针穿刺细胞学诊断能够为甲状腺疾病提供较为准确的术前诊断。六级诊断方法有助于临床治疗方案的选择。Objective To investigate the clinical application of fine needle aspiration （FNA） cytology of thyroid nodules. Methods A retrospective review was performed of 474 consecutive cases of FNA cytology of thyroid nodules from October 2005 to January 2011. Two hundred and eighteen patients underwent ultrasound-guided FNA, and 256 patients experienced palpation-guided FNA. Cytologic diagnoses were classified as unsatisfactory, benign, atypical cellular lesion, follicular neoplasm, suspicious for malignancy, and positive for malignancy. The discrepancies between initial cytologic diagnoses and histologic diagnoses were evaluated in 157 surgical specimens. Results According to the cytological categories, the rates for histologically confirmed malignancy in the 157 patients were as follows： 2/7 of unsatisfactory results, 16. 7% （9/54） of benign lesion, 3/9 of atypical cellular lesion, 1/3 of follicular neoplasm, 83.3% （ 35/42 ） of suspicious for malignancies, and 97.6% （41/42） of positive for malignancies. The sensitivity, specificity and positive predictive value of thyroid FNA for the diagnosis of malignancy were 85.4% , 86. 9% and 90. 5% , respectively. Conclusions FNA can provide an accurate diagnosis of thyroid malignancy preoperatively. The 6 diagnostic categories were beneficial for either clinical follow-up or surgical management of the patients with thyroid nodules.

关 键 词：甲状腺结节 活组织检查 细针 评价研究 

分 类 号：R736.1[医药卫生—肿瘤]