甲状腺结节影像学特征对FNAC诊断结果的影响  

Effect of imaging features of thyroid nodule on the diagnostic outcomes of FNAC

作　　者：王进芬 成娜[2] 吴涛[1] 童歌[1] 郑博文[1] 刘勇[2] 连宇帆 张红君[1] 郑荣琴[1] 任杰[1] Wang Jinfen, Cheng Na, Wu Tao, Tong Ge, Zheng Bowen, Liu Yong, LianYufan, Zhang Hongjun, Zheng Rongqin, Ren Jie.(Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Chin)

机构地区：[1]中山大学附属第三医院超声科,广州510630 [2]中山大学附属第三医院病理科,广州510630

出　　处：《新医学》2018年第6期411-415,共5页Journal of New Medicine

基　　金：中山大学5010计划培育项目(2016016)

摘　　要：目的探讨影响超声引导下甲状腺细针穿刺细胞学(FNAC)检查诊断结果的结节影像学特征。方法 442例甲状腺结节患者(463个结节),均接受FNAC检查,将结果按照Bethesda System分类标准分为无法诊断组(Ⅰ级)和适合诊断组(Ⅱ~Ⅵ级),比较2组结节的影像学特征,用Logistic回归分析影响FNAC检查诊断结果的影像学特征。结果无法诊断组为45例患者的45个结节(9.7%),适合诊断组为405例患者的418个结节(90.3%),FNAC无法诊断率为9.7%(45/463)。结节伴粗大钙化、环状钙化和中央供血是甲状腺结节FNAC检查的独立影响因素,其中结节伴粗大钙化(OR=2.82,95%CI 1.28~6.22,P=0.010)及环状钙化(OR=7.38,95%CI 1.77~30.80,P=0.006)是FNAC检查无法诊断的危险因素,结节伴中央供血(OR=0.12,95%CI 0.02~0.92,P=0.041)则是FNAC检查无法诊断的保护因素。结论甲状腺结节伴粗大钙化或环状钙化会增加FNAC无法诊断率,因此在行FNAC检查时应尽量避免穿刺粗大钙化、环状钙化区域。Objective To investigate the effect of imaging features of thyroid nodules upon the diagnostic outcomes of ultrasound-guided thyroid fine needle aspiration cytology（FNAC ） . Methods A total of 442 patients diagnosed with thyroid nodules （463 nodules） underwent FNAC examination. The results were classified into un-diagnosable （grade Ⅰ） and diagnosable （grade Ⅱ to Ⅵ） groups according to the Bethesda System classification criteria. The imaging features of the thyroid nodules were statistically compared between two groups. The effect of imaging features upon the diagnostic outcomes of FNAC was analyzed by Logistic regression analysis. Results In the un-diagnosable group, 45 patients with 45 thyroid nodules （9.7%） were assigned, and 405 patients with 418 thyroid nodules （90.3%） were allocated into the diagnosable group. The un-diagnosable rate of FNAC was calculated as 9.7% （45/463 ） . Nodules with macro-calcification, peripheral calcification, and central vascularity were the independent influencing factors for FNAC examination of thyroid nodules. Among these factors, thyroid nodules with macro-calcification （ OR=2.82, 95% CI： 1.28-6.22, P =0.010） and peripheral calcification （ OR=7.38, 95% CI： 1.77-30.80, P =0.006） were the risk factors for the un-diagnosable results by FNAC examination, whereas nodules with central vascularity （ OR=0.12, 95% CI： 0.02- 0.92, P =0.041） was a protective factor for the un-diagnosable outcomes by FNAC examination. Conclusions Thyroid nodules with macro-calcification or peripheral calcification will increase the un-diagnosable rate of FNAC. Therefore, it is recommended to avert the puncture in the area with gross and circular calcification during the FNAC examination.

关 键 词：甲状腺结节 活组织检查 细针 超声检查 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]