超声引导下粗针和细针穿刺活组织病理检查在甲状腺TI-RADS 4a级结节中的诊断价值  

Comparison of Diagnostic Values of Ultrasound-guided Fine-needle Aspiration Biopsy and Core-needle Aspiration Biopsy in Thyroid Imaging Reported and Data System Grade 4a Nodules

作　　者：张燕 刘海波 陈秋[2] ZHANG Yan;LIU Hai-bo;CHEN Qiu(Department of Medical Ultrasonics,Xinjin People's Hospital,Chengdu 611430,China;Department of Endocrinology,Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 611137,China)

机构地区：[1]新津人民医院超声科,成都611430 [2]成都中医药大学附属医院内分泌科,成都611137

出　　处：《临床误诊误治》2018年第8期23-27,共5页Clinical Misdiagnosis & Mistherapy

基　　金：教育部新世纪优秀人才支持计划项目(NCET-08-0903)

摘　　要：目的评价超声引导下粗针和细针穿刺活组织病理检查对甲状腺TI-RADS 4a级结节的诊断价值。方法选取接受手术治疗的甲状腺TI-RADS 4a级结节110例,根据超声引导下穿刺方法不同分为粗针穿刺组和细针穿刺组两组各55例,观察比较两组穿刺活组织病理检查结果,并与术后病理检查结果进行比较,评价粗针和细针穿刺活组织病理检查对甲状腺TI-RADS 4a级结节的诊断价值。结果粗针穿刺组未明确诊断3例,标本不满意1例;细针穿刺组未明确诊断7例,标本不满意9例。剔除未明确诊断和标本不满意的病例后,剩余90例超声引导下行粗针(25例)或细针(23例)穿刺诊断恶性结节48例,术后病理检查诊断恶性结节41例。粗针穿刺活组织病理检查对甲状腺TI-RADS 4a级结节的诊断敏感度为100.0%,特异度为86.7%;细针穿刺活组织病理检查对甲状腺TI-RADS 4a级结节的诊断敏感度为100.0%,特异度为84.2%。两组对甲状腺TI-RADS 4a级结节的诊断敏感度和特异度比较差异无统计学意义(P>0.05)。结论超声引导下粗针和细针穿刺活组织病理检查判断甲状腺TI-RADS 4a级结节性质均与术后病理检查诊断具有较高一致性;粗针穿刺活组织病理检查在取材方面有一定优势,细针穿刺活组织病理检查有创伤小及检查快速等优点。Objective To compare the diagnostic value of ultrasound-guided fine-needle aspiration biopsy(US-FNAB)and ultrasound-guided core-needle aspiration biopsy(US-CNAB)in thyroid nodules of thyroid imaging reported and data system(TI-RADS)category 4a.Methods A total of 110 patients with thyroid nodules of TI-DADS category 4a who underwent surgery in our department were enrolled.According to different aspiration biopsy methods,they were divided into US-CNAB group(n=55)and US-FNAB group(n=55).All pathological results of both needle biopsies and results of postoperative pathological examinations were observed and compared.In addition,the diagnostic values of US-FNAB and US-CNAB in thyroid nodules of TI-DADS category 4a were compared.Results In US-CNAB group,there were 3 undiagnosed cases and 1 with unsatisfactory specimen.By contrast,in US-FNAB group,there were 7 undiagnosed cases and 9 with unsatisfactory specimen.Excluding those with unsatisfactory specimens and undiagnosed cases,the remaining 90 cases underwent US-CNAB(n=25)or US-FNAB(n=23),to diagnose malignant nodules in 48 cases.In addition,41 cases of malignant nodules were diagnosed by postoperative pathological examination.The sensitivity and specificity of US-CNAB and US-FNAB in the diagnosis of thyroid nodules of TI-RADS category 4a were 100.0%vs 86.7%and 100.0%vs 84.2%,respectively.There was no significant difference between US-FNAB group and US-CNAB group(P>0.05).Conclusion The pathological diagnosis results by US-FNAB and US-CNAB were highly consistent with those by the postoperative pathological examination in identifying the nature of thyroid nodules of TI-DADS category 4a,Moreover,US-CNAB is advantageous over US-FNAB in terms of sampling,whereas US-FNAB has the advantages of smaller trauma and rapid detection.

关 键 词：甲状腺结节 超声检查 病理学 粗针穿刺 细针穿刺 

分 类 号：R581[医药卫生—内分泌] R736.1[医药卫生—内科学]