甲状腺结节细胞学无法诊断与超声图像特征关系的探索  

Ultrasonographic characteristic influencing of non-diagnostic results for ultrasound-guided fine-needle aspiration of thyroid nodules

作　　者：齐修竹 渠宁 高毅 陈敏 常才 Qi Xiuzhu;Qu Ning;Gao Yi;Chen Min;Chang Cai(Department of Medical Ultrasound,Fudan University Shanghai Cancer Center,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院超声诊断科,上海200032 [2]复旦大学附属肿瘤医院头颈外科,上海200032

出　　处：《中华超声影像学杂志》2018年第12期1058-1063,共6页Chinese Journal of Ultrasonography

基　　金：上海市科委引导项目(17411963300);上海申康医院发展中心临床科技创新项目(SHDC22015016).

摘　　要：目的探索超声引导下细针穿刺(ultrasound-guided fine-needle aspiration,US-FNA)细胞学无法诊断的甲状腺结节的超声特征。方法回顾性收集2013年6月至2015年9月在复旦大学附属肿瘤医院超声科行US-FNA检查的1009例患者的1034个甲状腺结节的超声特征、细胞学及组织学诊断结果,并采用Logistic回归分析穿刺细胞学无法诊断的影响因素。结果1034个甲状腺结节行US-FNA后,174个(16.8%)细胞学无法诊断,其余860个(83.2%)诊断满意。单因素分析提示年龄、回声、纵横比、钙化类型、边缘、结节深度与细胞学无法诊断有密切关系(均P<0.05)。多因素分析提示患者年龄≥45岁、结节最大径≤10mm、纵横比<1、结节位于腺体中层及后层、结节伴粗大钙化是细胞学无法诊断的独立危险因素(均P<0.05)。结论患者年龄≥45岁、结节最大径≤10mm、纵横比<1、结节位于腺体中层及后层、结节伴粗大钙化是导致甲状腺结节超声引导下细针穿刺细胞学无法诊断的独立影响因素。对于有上述特征的甲状腺结节建议选择密切随访,若有发展选择手术治疗。Objective To explore the clinical and ultrasonographic characteristics leading to non-diagnostic results after ultrasound-guided fine-needle aspiration(US-FNA)in patients with thyroid nodules.Methods One thousand and thirty-four thyroid nodules of 1 009 patients who underwent US-FNA from June 2013 to September 2015 in Fudan University Shanghai Cancer Center were included in this study.The ultrasonographic characteristics,cytological and histological diagnosis were collectecl.Univariate and multivariate logistic methods were applied to analyze the factors bringing about non-diagnostic results.Results Of the 1 034 nodules,174(16.8%)had non-diagnostic results and 860(83.2%)had diagnostic results.Age,echogenicity,anteroposterior/transverse diameter ratio(AT),calcification,margin and depth were associated with nondiagnostic results.Age≥45 years,the largest diameter≤10 mm,AT<1,located at the middle 1/3 and dorsal 1/3 in the cross section of nodules,macrocalcification were proved as independent influencing factors for non-diagnostic results of FNA.Conclusions Age≥45 years,the largest diameter≤10 mm,AT<1,located at the middle 1/3 and dorsal 1/3 in the cross section of nodules,macrocalcification are independent influencing factors of non-diagnostic results.As a result,for nodules with the characteristics above it may recommend follow up instead of FNA.During follow-up,it may recommend surgery if the nodule has progressed.

关 键 词：超声检查 超声引导下细针穿刺 甲状腺结节 细胞学诊断 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]