超声引导下粗针活检在初次细针抽吸活检诊断不明的甲状腺结节中的应用  

Application of ultrasound-guided core needle biopsy in the diagnosis of nondiagnostic thyroid nodules by initial fine needle aspiration biopsy

作　　者：苏雪娇 赵海娜[1] 马步云[1] 姜勇[1] 周洁宏[1] SU Xue-jiao;ZHAO Hai-na;MA Bu-yun;JIANG Yong;ZHOU Jie-hong(West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院,四川成都610041

出　　处：《中国临床医学影像杂志》2022年第12期847-853,共7页Journal of China Clinic Medical Imaging

基　　金：成都市科技项目(2021-YF05-01414-SN)。

摘　　要：目的:评估超声引导下粗针活检(CNB)在初次细针抽吸活检(FNAB)诊断不明的甲状腺结节中的应用价值。方法:收集初次FNAB后细胞学诊断不明而应用CNB进行组织学诊断的甲状腺结节患者92例,FNAB、CNB病理结果分别参照TBSRTC分类、韩国甲状腺学会的标准。FNAB诊断不明的包括甲状腺细胞病理学Bethesda报告系统(TBSRTC)Ⅰ、Ⅲ、Ⅳ、Ⅴ类和超声图像提示为恶性但FNAB结果为TBSRTCⅡ类,分析评估CNB的取材满意率、诊断效能及并发症。结果:CNB取材满意率高于初次FNAB(85.86%vs.61.97%,P<0.05),标本确诊率为55.43%,甲状腺结节恶性诊断率为48.91%,紧邻被膜者的出血概率低于未紧邻被膜者(16.47%vs.71.43%,P<0.05)。结论:超声引导下CNB的取材满意率、确诊率及恶性诊断率均高于初次FNAB,未紧邻被膜的结节是CNB后出血的风险因素。初次FNAB诊断不明的甲状腺结节,再次穿刺时可采用超声引导下CNB的方法。Objective:To assess the value of ultrasound-guided core needle biopsy(CNB)in the diagnosis of nondiagnostic thyroid nodules by initial fine-needle aspiration biopsy(FNAB).Methods:We collected 92 patients with thyroid nodules whose cytological diagnosis was nondiagnostic after the initial FNAB and so histological diagnosis was thereafter performed using CNB.The pathological results of FNAB and CNB were based on the criteria of TBSRTC classification and Korean Thyroid Society,respectively.Undetermined FNAB diagnoses included the Bethesda system for reporting thyroid cytopathology(TBSRTC)Ⅰ,Ⅲ,Ⅳ,Ⅴand ultrasound images suggestive of malignancy but FNAB results were TBSRTCⅡ.The sampling satisfaction rate,diagnostic efficacy and complications of CNB were analyzed and assessed.Results:The satisfactory rate of CNB sampling was higher than that of initial FNAB(85.86%vs.61.97%,P<0.05).The specimen confirmation rate was 55.43%.The diagnostic rate of malignant thyroid nodules was 48.91%.The probability of bleeding immediately adjacent to the capsule was lower than that not adjacent to the capsule(16.47%vs.71.43%,P<0.05).Conclusion:The satisfactory rate of ultrasound-guided CNB and the diagnostic rate of malignant diagnosis are higher than those of the initial FNAB.For thyroid nodules with undetermined diagnosis by the initial FNAB,ultrasound-guided CNB can be used during re-puncture.

关 键 词：甲状腺结节 活组织检查 针吸 超声检查 介入性 

分 类 号：R736.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学]