US-FNA及US-CNB在甲状腺微小结节中的诊断价值及影响因素分析  

Diagnostic value and influencing factors of US-FNA and US-CNB in thyroid micro-nodules

作　　者：张中原 崔岱[2] 徐刚[3] ZHANG Zhong-yuan;CUI Dai;XU Gang(Department of Thyroid,Nanjing Tongren Hospital Affiliated Medical College of Southeast University,Naijing 232001;Department of Endocrinology,Jiangsu Provincial Hospital,Nanjing 210029;Department of General Surgery,Nanjing Tongren Hospital Affiliated Medical College of Southeast University,Naijing 211102,Jiangsu,China)

机构地区：[1]东南大学医学院附属南京同仁医院甲状腺科,江苏南京211102 [2]江苏省人民医院内分泌科,江苏南京210029 [3]东南大学医学院附属南京同仁医院普外科,江苏南京211102

出　　处：《川北医学院学报》2021年第12期1577-1580,共4页Journal of North Sichuan Medical College

基　　金：江苏省“六大人才高峰”项目(2016-WSN-023)。

摘　　要：目的:比较超声引导下细针抽吸细胞学检查(US-FNA)与超声引导下粗针穿刺组织学检查(US-CNB)在甲状腺微小结节中的诊断价值及影响因素分析。方法:选取同时行US-FNA与US-CNB的4a类以上的甲状腺微小结节113例,以术后病理作为金标准,比较US-FNA与US-CNB的准确率、灵敏度、特异度、阳性预测值、阴性预测值;并分析结节的大小、位置、血供、性状、钙化对诊断结果的影响。结果:以术后病理结果为金标准,US-FNA和US-CNB在甲状腺微小结节中诊断中的特异度和阴性预测值比较,差异均具有统计学意义(P<0.05),而在准确率、灵敏度、阳性预测值方面比较,差异均无统计学意义(P>0.05)。US-FNA和US-CNB对血供丰富组、非实性组、周围组、粗大钙化甲状腺微小结节的诊断准确率比较,差异均有统计学意义(P<0.05)。影响US-FNA准确率的因素有结节的血供、性状、钙化状况,而影响US-CNB准确率的因素有结节的直径、位置、钙化状况。结论:US-FNA是甲状腺微小结节术前诊断的首选方法,具有很高的应用价值,而对于血供丰富、囊性、粗大钙化的结节US-CNB是一种很好的补充诊断方法。Objective:To compare the diagnostic value and influencing factors of Ultrasound-guided fine needle aspiration cytology(US-FNA)and Ultrasound-guided core needle biopsy histology(US-CNB)in thyroid micro-nodules.Methods:We selected 113 cases of thyroid micronodules above category 4a who underwent US-FNA and US-CNB at the same time.Postoperative pathology was used as the gold standard.The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of US-FNA and US-CNB were compared.And analyze the influence of the size,location,blood supply,traits,and calcification of nodules on the diagnosis results.Results:Taking postoperative pathology as the gold standard,there was significant difference in the specificity and negative predictive value of US-FNA and US-CNB in the diagnosis of thyroid micro nodules(P<0.05),but there was no significant difference in accuracy,sensitivity and positive predictive value(P>0.05).There were significant differences in the diagnostic accuracy of US-FNA and US-CNB in rich blood supply group,non solid group,surrounding group,coarse calcified thyroid nodules(P<0.05).The factors affecting the accuracy of the US-FNA include the blood supply,characteristics,and gross calcification of the nodule,and the factors affecting the accuracy of the US-CNB include the diameter,location,and gross calcification of the nodule.Conclusion:US-FNA is the first choice for preoperative diagnosis of thyroid micronodules and has high application value.US-CNB is a good supplementary diagnostic method for some nodules with abundant blood supply,cystic,and large calcification.

关 键 词：甲状腺微小结节 粗针穿刺 细针抽吸 超声引导 诊断价值 

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]