超声引导下细针穿刺细胞学在TI-RADS 4-6类甲状腺病变中的应用价值  

Value of ultrasound-guided fine needle aspiration biopsy in diagnosing thyroid nodules of TI-RADS 4-6 categories

作　　者：邓红艳[1] 叶新华[1] 栗翠英[1] 林红军[1] 斯岩[2] 陆婉[2] 

机构地区：[1]南京医科大学附属第一医院江苏省人民医院超声诊断科,210009 [2]南京医科大学附属第一医院江苏省人民医院综合外科,210009

出　　处：《中华超声影像学杂志》2014年第9期773-777,共5页Chinese Journal of Ultrasonography

摘　　要：目的 探讨超声引导下细针穿刺细胞学（FNAB）在常规超声TI-RADS 4-6类甲状腺病变中的应用价值.方法 回顾性分析行常规超声TI-RADS分类同时进行超声引导下FNAB的494例患者（共501个结节）,筛选出TI-RADS 4-6类患者163例共168个结节,分为三组：Ⅰ组,TI-RADS 4A类;Ⅱ组,TI-RADS 4B类;Ⅲ组,TI-RADS 5-6类（6类中除去已经病理证实者）.以手术病理为金标准,计算三组超声引导下FNAB诊断准确性、敏感性、特异性、阳性预测值,并绘制ROC曲线评价其应用价值.结果 超声引导下FNAB的准确性、敏感性、特异性、阳性预测值Ⅰ组分别为74.4％、73.3％、75.0％、64.7％,Ⅱ组分别为83.9％、87.5％、71.4％、91.3％,Ⅲ组分别为89.3％、91.7％、75.0％、95.7％.超声引导下FNAB对Ⅰ组、Ⅱ组的阳性预测值高于TI-RADS分类标准,差异有统计学意义;对Ⅲ组的阳性预测值与TI-RADS分类标准相近,差异无统计学意义.结论 联合应用TI-RADS分类标准与FNAB,可提高工、Ⅱ组的诊断准确率,降低Ⅲ组的穿刺率.Objective To explore the application value of ultrasound-guided fine needle aspiration biopsy（FNAB） in diagnosing thyroid nodules of TI-RADS 4-6 categories.Methods A retrospective analysis was made on the pathologic data of 494 patients （totally 501 nodules） who underwent TI-RADS ultrasonographic stratification and ultrasound-guided FNAB.168 thyroid nodules of TI-RADS 4-6 categories were selected from 163 patients and classified into three groups：group T,TI-RADS 4A categories;group Ⅱ,TI-RADS 4B category; group Ⅲ,TI-RADS 5-6 category（the pathologically confirmed cases in category 6 had been removed）.The ultimate pathologic findings were taken as golden standards to calculate the accuracy,sensitivity,specificity,positive predictive value of ultrasound-guided FNAB in the three groups.ROC curve was drawn to evaluate the diagnostic value of FNAB.Results The accuracy,sensitivity,specificity,positive predictive value of the ultrasound-guided FNAB in the three groups were listed as follows：group Ⅰ 74.4%,73.3%,75.0%,64.7%;group Ⅱ 83.9%,87.5%,71.4%,91.3%;group Ⅲ 89.3%,91.7 %,75.0%,95.7 % respectively.The positive predictive values of the ultrasound-guided FNAB for group Ⅰ and group Ⅱ was higher than that of conventional TI-RADS classification criteria,so the difference was statistically significant; while the positive predictive values for group Ⅲ was close to the conventional ultrasound TI-RADS classification criteria,the difference was not statistically significant.Conclusions The combination application of TI-RADS classification criteria and FNAB can improve the accuracy of ultrasound diagnosis in group Ⅰ and group Ⅱ,and reduce the puncture rate of group Ⅲ.

关 键 词：超声检查 甲状腺结节 活组织检查 细针 TI-RADS 4-6类 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581.3[医药卫生—诊断学]