超声引导下甲状腺结节粗针活检取材满意率及结节治疗方法的预测分析  

Ultrasound-guided core needle biopsy on the thyroid nodules： the adequacy and the predicting factors for the nodule management

作　　者：李乾[1] 王彬[1] 邵玉红[1] 陈路增[1] 高莹[2] 赵静[3] 

机构地区：[1]北京大学第一医院超声诊断科,100034 [2]北京大学第一医院内分泌科,100034 [3]北京大学第一医院病理科,100034

出　　处：《中华医学杂志》2014年第11期859-862,共4页National Medical Journal of China

摘　　要：目的 研究甲状腺结节首次行粗针活检的取材满意率及预测结节治疗方法的因素.方法 收集北京大学第一医院2012年6月-2013年6月的甲状腺结节首次超声引导下粗针穿刺活检患者资料,记录患者年龄、性别、病变的超声特征及穿刺病理结果.结果 共162个结节人选,取材满意率为97.5％（158/162,95％ CI 93.8％ ～99.3％）.参照Bethesda诊断系统,治疗方法确定的153个结节中,拟随访64个（64/153,41.8％,95％ CI 34.0％ ～ 49.6％）,拟手术89个（89/153,58.2％,95％ CI 50.4％～66.0％）.病变内部血流和边界是预测病变是否需要手术治疗的独立因素（P＜0.05）.1例患者穿刺后出现局部血肿.结论 超声引导下甲状腺结节粗针穿刺活检的取材满意率和安全性均较高,病变内部血流和边界是预测病变是否需要手术治疗的独立因素.Objective To explore the adequacy of the initial ultrasound-guided core needle biopsy （CNB） on the thyroid nodules and the potential factors for predicting the management of the nodules. Methods Retrospectively collected the subjects who underwent the CNB on the thyroid nodules within one year, with the inclusion criteria： （ 1 ） initial CNB on the thyroid nodules, （2） underwent the ultrasound scanning 1 month before the biopsy. The following data were recorded, which were the patient＇s age, sex, the lesion＇s sonographic findings （size, number, content, margin, echo, calcification, and internal vascularity）, and histopathology. The CNB pathological diagnostic criterion was set up referring to the Bethesda System for Reporting Thyroid Cytopathology （ BSRTC ）. Results One hundred and fifty-seven patients with 162 nodules were enrolled, and the adequacy of the CNB was 97.5% （ 158/162, 95% C1 93.8% -99.3% ）. Referring to the BSRTC, of all the 153 nodules with determined management, 64 （64/ 153,41.8%, 95% CI 34. 0% - 49. 6% ） were to be followed up only, and 89 （ 89/153,58.2%, 95% CI 50. 4% -66. 0% ）were to be undergone nodule excision. Three of the sonographic findings, including lesion margin, echogenicity, and internal vascularity, were significantly associated with the management of the nodules （P 〈 O. 05）, and the internal vascularity and margin were demonstrated as the independent factors for predicting the nodule excision by using the logistic regression model （ Odds Ratio = 2. 942, 2. 767, P 〈 O. 05）. Only one case of moderate localized hematoma was observed in this series. Conclusion As long as the specification of biopsy operation and pathology interpretation, the procedure of CNB on the thyroid nodules is safe with high adequacy as well. The sonographic margin and internal vascularity of the lesion are the independent factors for predicting the nodule excision.

关 键 词：甲状腺结节 活组织检查 粗针 活组织检查 细针 超声检查 

分 类 号：R445.1[医药卫生—影像医学与核医学]