细针穿刺细胞学与术中冷冻病理诊断对甲状腺结节手术的指导价值探讨  

The value of frozen sections and fine needle aspiration cytology in thyroid nodule surgery

作　　者：李锐[1] 曹丁方 张雪 赵延明[2] 刘红刚[1] Li Rui;Cao Dingfang;Zhang Xue;Zhao Yanming;Liu Honggang(Department of Pathology,Key Laboratory of Head and Neck Molecular Diagnostic Pathology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otolaryngology,Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院病理科/头颈部分子病理诊断北京市重点实验室,北京100730 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730

出　　处：《中国医刊》2022年第7期775-778,共4页Chinese Journal of Medicine

基　　金：北京市医管局2018年度“扬帆计划”重点医学专业项目(ZYLX201814)。

摘　　要：目的探讨超声引导下细针穿刺细胞学(fine needle aspiration cytology,FNA)与术中冷冻病理诊断对甲状腺结节手术的指导价值。方法选取2018年1月至2021年1月在首都医科大学附属北京同仁医院接受甲状腺手术并进行术中冷冻病理检查,且术前有FNA结果的甲状腺结节患者491例(547个结节),回顾性分析其临床资料,采用Bethesda分类法将547个结节分为6类,分析FNA和冷冻病理在不同类别甲状腺结节中的诊断准确率,并通过对其中335例行单侧腺叶切除或部分甲状腺切除患者的术式分析,评估术中冷冻病理的手术指导价值。结果除Ⅵ类结节外,冷冻病理的诊断准确率均高于FNA;冷冻病理的敏感度、特异度、阳性预测值、阴性预测值均高于FNA;335例患者中有38例(11%)根据冷冻病理结果修改了手术方式,其中37例(97.4%)经术后石蜡病理证实正确;在Ⅲ、Ⅳ类结节患者中根据冷冻病理结果改变手术方式的比例最高(54.8%),而在Ⅵ类结节患者中该比例最低(0.5%,1/186)。结论术中冷冻病理对于FNA不能确定诊断的甲状腺结节具有一定手术指导价值,而对于FNA已经明确诊断的结节其手术指导价值较低。Objective To evaluate the usefulness on surgical management of frozen sections(FS)in different types of fine needle aspiration cytology(FNA).Method A retrospective analysis was done on 491 patients who underwent thyroid surgery following FS with a preoperative FNA from January 2018 to January 2021 in Beijing Tongren Hospital affiliated to Capital Medical University,and 547 nodules were divided into 6 categories by Bethesda classification.The diagnostic accuracy of FNA and FS in different types of thyroid nodules was analyzed,and the surgical guidance value of FS was evaluated on 335 patients who underwent lobectomy or partial thyroidectomy.Result The diagnostic accuracy of FS was higher than FNA except for Ⅵ nodules.The sensitivity,specificity,positive predictive value and negative predictive value of FS were higher than those of FNA.In terms of surgical guidance,FS modified surgical procedures in 38 of 335 cases(11%),and 97.4%of them were confirmed to be correct,which was the most in class Ⅲ and Ⅳ nodules(54.8%)and the least in class Ⅵ nodules(0.5%,1/186).Conclusion There may be some utility for FS in lesions with indeterminate FNA,but has little value for nodules with definite diagnosis.

关 键 词：甲状腺结节 术中冷冻病理 细针穿刺细胞学 

分 类 号：R736.1[医药卫生—肿瘤]