超声引导下甲状腺结节细针穿刺及量化分级系统的临床价值  

Value of quantitative grading system of ultrasonography and ultrasound-guided fine needle aspiration biopsy in thyroid nodules

作　　者：周伟[1] 宋琳琳[1] 徐上妍[1] 胡赟赟[1] 倪晓枫[1] 詹维伟[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院超声科,上海200025

出　　处：《医学影像学杂志》2014年第7期1131-1134,共4页Journal of Medical Imaging

摘　　要：目的探讨甲状腺超声量化分级系统和超声引导下细针穿刺抽吸活检(US-FNAB)对甲状腺结节的临床应用价值。方法回顾性分析US-FNAB且手术病理证实的260例患者甲状腺结节285个,将甲状腺结节按超声量化分级系统进行分级,将分级结果及US-FNAB细胞学结果与手术组织学结果进行对照。结果超声量化分级系统的敏感度为87.7%(200/228)、特异度为61.4%(35/57)、阳性预测值为90.1%(200/222)、阴性预测值为55.6%(35/63)、准确率为82.5%(235/285)。US-FNAB的敏感度为88.2%(201/228)、特异度为77.2%(44/57)、阳性预测值为93.9%(201/214)、阴性预测值为62.0%(44/71)、准确率为86.0%(245/285)。US-FNAB诊断甲状腺阴性结节71个,按3级、4A、4B及5级分类其恶性率分别为0.0%、16.7%、56.5%及58.8%。US-FNAB假阳性结果13个中超声阳性5个,超声阴性8个。US-FNAB假阴性结果27个中超声阳性23个,超声阴性为4个。结论超声量化分级系统与US-FNAB对甲状腺结节具有较高的诊断价值,超声量化分级系统可作为进行US-FNAB的准入指标,同时可对部分结节穿刺后临床处理提供指导作用。Objective To evaluate the clinical guidance value of quantitative grading system of ultrasonography and ultrasound-guided fine needle aspiration biopsy（US-FNAB）for the management of thyroid nodules.Methods 285 nodules in260patients with US-FNAB were enrolled in the study,which were pathologically confirmed by surgery.We classified these nodules by the quantitative grading system of ultrasonography.Ultrasonographic grade findings and cytological findings were compared with histological results.Results The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of the quantitative grading system were 88.2%（201/228）,77.2%（44/57）,93.9%（201/214）,62.0%（44/71）,86.0%（245/285）,respectively.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of US-FNAB were 88.2%（201/228）,77.2%（44/57）,93.9%（201/214）,62.0%（44/71）,86.0%（245/285）,respectively.Of 71 nodules with negative cytological results,the malignancy rates of Grade 3,4A,4B,5were 0.0%,16.7%,56.5%,58.8%,respectively.Of 13 nodules with false positive cytological results,8were negative according to the quantitative grading system.Of 27 nodules with false negative cytological results,23 were positive according to the quantitative grading system.Conclusion The quantitative grading system of ultrasonography and US-FNAB are effective diagnostic procedures for thyroid nodules.The quantitative grading system was considered a permit standard to perform US-FNAB on patients with thyroid nodules,and was helpful in decision making about some thyroid nodules after US-FNAB.

关 键 词：甲状腺结节 超声检查 量化分级系统 超声引导下细针穿刺活检 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]