甲状腺细针穿刺细胞学误诊及漏诊的临床病理分析  

The pathological analysis of misdiagnosis and missed diagnosis of thyroid fine-needle aspiration cytology

作　　者：华威[1] 李嘉瑶[1] 王超萃 戚基萍[1] 朱宏[1] 鹿芃恬 吴鹤[1] 刘微[1] HUA Wei;LI Jia-yao;WANG Chao-cui;QI Ji-ping;ZHU Hong;LU Peng-tian;WU He;LIU Wei(Department of Pathology,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院病理科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2020年第6期606-611,共6页Journal of Harbin Medical University

摘　　要：目的探讨甲状腺细针穿刺(FNA)细胞学诊断价值,并对良、恶性病变误诊及漏诊进行分析。方法回顾性分析1 188例甲状腺细针穿刺细胞学诊断结果,评估各项诊断效能(敏感性、特异性、准确性等相关诊断指标)。将细胞学结果与组织学结果对照,分析误诊及漏诊的原因。结果细针穿刺细胞学诊断的敏感性为97.75%,特异性78.95%,阳性预测值95.60%,阴性预测值88.24%,准确性94.44%,误诊率5.48%。细胞学诊断误诊8例,漏诊4例,结节部位、穿刺手法,病灶纤维化、钙化、囊性变等因素导致具有诊断价值细胞获取的多少以及制片质量的优劣是细胞学误诊、漏诊的主要原因。结论细针穿刺细胞学对于甲状腺结节的判读存在一定的误诊和漏诊,联合应用基因检测和免疫细胞化学可以辅助诊断,进一步提高诊断准确率。Objective To investigate the value of thyroid fine-needle aspiration(FNA) cytology diagnosis and analyze the misdiagnosis and missed diagnosis of benign and malignant lesions. Methods A total of 1 188 cases of thyroid FNA were analyzed retrospectively. The sensitivity, specificity and accuracy of cytological diagnosis were analyzed. The reasons for misdiagnosis and missed diagnosis were analyzed by comparing the cytological results with the histological results. Results The sensitivity of fine needle aspiration cytology diagnosis was 97.75%, specificity was 78.95%, positive prediction value was 95.60%, negative prediction value was 88.24%, accuracy was 94.44%, and misdiagnosis rate was 5.48%. Eight cases of cellular diagnosis misdiagnosed, 4 cases missed. The main reason for cytological misdiagnosis and missed diagnosis was the factors that caused not enough diagnosis of cells in lesions, including nodule site, size, lesion fibrosis, calcification and cystic changes. Conclusion FNA cytology has certain misdiagnosis and missed diagnosis of thyroid nodules. Clinical auxiliary diagnosis with gene detection and immunocytochemistry can further improve the diagnostic accuracy.

关 键 词：细针穿刺 细胞学 甲状腺结节 甲状腺癌 

分 类 号：R365[医药卫生—病理学]