桥本甲状腺炎对≥1cm甲状腺结节超声引导下细针穿刺细胞学检查诊断效能的影响  

The effect of Hashimoto’s thyroiditis on the diagnostic efficacy of ultrasound-guided fine needle aspiration cytology for thyroid nodules≥1cm

作　　者：侯佳欣 李茂萍[1] 彭晓琼[1] 李颖颖 刘丽萍[1] HOU Jiaxin;LI Maoping;PENG Xiaoqiong;LI Yingying;LIU Liping(Department of Ultrasound,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400012,China)

机构地区：[1]重庆医科大学附属第一医院超声科,重庆400012

出　　处：《临床耳鼻咽喉头颈外科杂志》2021年第9期807-812,共6页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨超声引导下细针穿刺细胞学检查(US-FNAC)对≥1 cm甲状腺结节的诊断效能,及合并桥本甲状腺炎(HT)对诊断效能的影响。方法:回顾性分析1027例≥1 cm行US-FNAC的甲状腺结节患者的临床资料,所有患者均行二维超声检查及BRAFV600E基因检测,并对其进行随访,手术者以术后病理结果为判定标准,未手术者结合二维超声检查、临床特征、随访结果及BRAFV600E判定,比较HT(+)组与HT(-)组US-FNAC诊断效能,分析影响诊断效能的因素。结果:1027例结节中,无法诊断或标本不满意73例(7.1%),良性282例(27.5%),意义不明确的细胞非典型病变或意义不明确的滤泡病变230例(22.4%),滤泡肿瘤或可疑的滤泡肿瘤20例(1.9%),可疑恶性肿瘤120例(11.7%),恶性302例(29.4%)。515例行结节手术,其中恶性肿瘤495例,良性20例;512例未手术继续随访,均为BRAFV600E野生型,结合二维超声检查、临床特征、随访结果,判定其为良性。US-FNAC的准确度、灵敏度、特异度、阳性预测值、阴性预测值、假阳性率和假阴性率分别为98.7%、98.4%、99.3%、99.5%、97.5%、0.7%和1.6%。HT(+)组的准确度、灵敏度、阴性预测值分别为95.5%、95.4%、82.8%,低于HT(-)组的99.5%、99.4%、99.2%(P=0.001、0.018及P<0.001),HT(+)组的假阴性率(4.6%)高于HT(-)组(0.6%)(P=0.018),且HT为假阴性率升高的危险因素(OR=7.596,95%CI:1.452~39.740)。结论:US-FNAC是甲状腺结节诊断的有效手段,在≥1 cm结节中,灵敏度和特异度高,但合并HT降低了诊断准确度,且HT为假阴性率升高的危险因素。Objective:To explore the diagnostic efficacy of ultrasound-guided fine needle aspiration cytology(US-FNAC)for thyroid nodules≥1 cm,and the effect of Hashimoto’s thyroiditis(HT)on it.Methods:The clinical data of 1027 cases of thyroid nodules≥1 cm were retrospectively analyzed.Two-dimensional ultrasound,US-FNAC and BRAFV600 E gene testing were performed.The postoperative pathological results were used as the criterion.The two dimensional ultrasound examination,clinical characteristics,follow-up results,and BRAFV600 E were used to diagnosis for unoperated patients.The diagnostic efficiency of US-FNAC in HT(+)group and HT(-)group was compared,and the factors affecting the diagnostic efficiency were analyzed.Results:Of the 1027 nodules,the cytological results were nondiagnostic/unsatisfactory in 73 nodules(7.1%),benign in 282(27.5%),atypia of undetermined significance/follicular lesion of undetermined significance in 230(22.4%),follicular neoplasm/suspicious for a follicular neoplasm in 20(1.9%),suspicious for malignancy in 120(11.7%),and malignant in 302(29.4%).515 cases underwent surgery.Among them,495 were malignant and 20 were benign.512 cases continued to be followed up without surgery,and the BRAFV600 E of them were wild type.Combined with the two dimensional ultrasound examination,clinical features,and follow-up results,they were judged to be benign.The accuracy,sensitivity,specificity,positive predictive value,negative predictive value,false positive rate and the false negative rate the of US-FNAC were 98.7%,98.4%,99.3%,99.5%,97.5%,0.7%and 1.6%,respectively.The accuracy,sensitivity and negative predictive value of the HT(+)group were 95.5%,95.4%and 82.8%,respectively,which were lower than that of HT(-)group(99.5%,99.4%,99.2%)(P=0.001,0.018,P<0.001).The false negative rate of the HT(+)group was 4.6%,higher than 0.6%of the HT(-)group(P=0.018),and HT was an risk factor for increased FNR(OR=7.596,95%CI:1.452-39.740).Conclusion:US-FNAC is an effective method for the diagnosis of thyroid nodules and it has hig

关 键 词：甲状腺结节 细针穿刺细胞学 甲状腺炎 BRAFV600E 

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]