不同穿刺方法对甲状腺结节细胞学检查的应用  

Application of different puncture methods to cytological examination of thyroid nodule

作　　者：柴吉鑫[1] 张雪 何时知 齐艳涛 王婧婧 敖亚洲[1] 陈泳[1] Chai Jixin;Zhang Xue;He Shizhi;Qi Yantao;Wang Jingjing;Ao Yazhou;Chen Yong(Department of Thyroid Surgery,Affiliated Hospital of Chengde Medical College,Chengde Hebei Province 067000,China;Department of Otorhinolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100010,China)

机构地区：[1]承德医学院附属医院甲状腺外科,河北承德067000 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100010

出　　处：《中华普外科手术学杂志（电子版）》2023年第3期315-318,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：河北省承德市科学技术研究与发展计划项目(201801A049);北京白求恩公益基金会2021甲状腺中青年医生研究项目(BQE-JZX-202107)。

摘　　要：目的探究不同穿刺方法对患者甲状腺结节细胞学检查的应用。方法回顾性分析2018年4月至2019年6月接受超声引导下甲状腺结节细胞学检查的120例患者,依据穿刺方法不同分成A组和B组,每组各60例。A组接受无负压细针穿刺细胞学检查(FNNAC),B组接受持续负压细针穿刺细胞学检查(FNAC),采用SPSS 21.0软件进行分析,计量资料以(x^(-)±s)表示,独立样本t检验;所有的计数资料用χ^(2)检验。采用Kappa检验方法,以手术病理学活检诊断结果为标准,对两组患者细胞学诊断结果进行一致性比较。P<0.05为差异有统计学意义。结果两组患者细胞学检查结果甲状腺结节平均大小、结节血流状况、结节数量、钙化情况以及内成分等比较差异均无统计学意义(P>0.05)。与术后病理学活检诊断结果相比较,两组穿刺方法的阳性预测值、阴性预测值、灵敏度、特异度、约登指数以及诊断准确率相比差异无统计学意义(P>0.05)。A组与B组穿刺方法细胞学诊断结果与病理学诊断结果的Kappa检验值为0.630和0.621,两种穿刺方法诊断结果与病理学诊断结果存在一致性(P<0.05),且两种方法与病理学诊断结果的一致性类似(Kappa值相近)。结论有无负压的细针穿刺方法在患者甲状腺结节诊断中效果类似,与病理学诊断结果存在一致性,可根据临床需要进行选择性穿刺并涂片。Objective To explore the application of different puncture methods for cytological examination of thyroid nodule in patients.Methods A total of 120 patients who received ultrasound-guided thyroid nodule cytology from April 2018 to June 2019 were retrospectively analyzed and divided into 2 groups according to different puncture methods.Group A received negative pressure fine needle puncture cytology(FNNAC),group B received continuous negative pressure fine needle puncture cytology(FNAC),SPSS 21.0 software was used for analysis,measurement data were expressed as(x^(-)±s),independent sample t test.All the data were tested byχ^(2)test.Kappa test was used to compare the cytological diagnosis results between the two groups based on the diagnostic results of surgical pathology biopsy.P<0.05 was considered statistically significant.Results There were no significant differences in the average size of thyroid nodule,nodule blood flow,nodule number,calcification and internal composition between 2 groups(P>0.05).Compared with the diagnostic results of postoperative pathological biopsy,there were no significant differences in positive predictive value,negative predictive value,sensitivity,specificity,Yoden index and diagnostic accuracy between the two groups of puncture methods(P>0.05).The Kappa test values of cytological diagnosis results and pathological diagnosis results of puncture methods in group A and Group B were 0.630 and 0.621,and the diagnostic results of the two puncture methods were consistent with the pathological diagnosis results(P<0.05),and the consistency of the two methods with the pathological diagnosis results was similar(similar Kappa value).Conclusion Fine needle puncture with or without negative pressure has similar effect in the diagnosis of thyroid nodule in patients,which is consistent with the pathological diagnosis results.Selective puncture and smear can be performed according to clinical needs.

关 键 词：甲状腺结节 无负压 持续负压 细胞学检查 疗效比较研究 

分 类 号：R581[医药卫生—内分泌]