细针穿刺病理检查鉴别甲状腺结节良恶性的价值及其穿刺标本质量的影响因素分析  

Value of fine needle puncture pathological examination in differentiating benignfrom malignant thyroid nodules and analysis of influencing factors on the qualityof puncture specimens

作　　者：郭珊岚 张琳 周洁 李静 王卫[1] 李长芬 沈洋 陶世冰[2] GUO Shanlan;ZHANG Lin;ZHOU Jie;LI Jing;WANG Wei;LI Changfen;SHEN Yang;TAO Shibing(Department of Pathology,Ziyang First People's Hospital,Sichuan Ziyang 641300,China;Department of Endocrinology,Ziyang First People's Hospital,Sichuan Ziyang 641300,China)

机构地区：[1]资阳市第一人民医院病理科,四川资阳641300 [2]资阳市第一人民医院内分泌科,四川资阳641300

出　　处：《现代肿瘤医学》2024年第16期2999-3004,共6页Journal of Modern Oncology

基　　金：四川省医学科研课题计划(编号:S20066)。

摘　　要：目的:探讨超声引导下的细针穿刺病理检查对甲状腺结节良恶性的鉴别价值,并分析其穿刺标本质量的影响因素。方法:收集2017年01月至2021年12月于我院行甲状腺结节细针穿刺活检的577例患者临床资料,其中79例(100个结节)接受了甲状腺手术切除并获得组织学病理结果,以手术病理学结果为诊断金标准,分析超声引导下细针穿刺病理检查对甲状腺结节良恶性的鉴别价值,采用二元logistics回归系数分析其标本质量的影响因素。结果:细针穿刺活检恶性病变敏感性为98.48%,特异性为91.18%,准确性为96.00%。细针穿刺活检病理检查与组织学病理检查病理分型结果一致性显示,Kappa值为0.914(P<0.05)。与非优良组相比,优良组诊断敏感性、特异性、准确性更高(P<0.05)。与诊断优良组相比,非优良组>1 cm占比更少,存在钙化占比更多(P<0.05);优良组穿刺标本细胞数量更充足,细胞蜡块制备效果更佳。二元logistics回归系数分析显示,最大直径、钙化是细针穿刺标本质量的重要影响因素(P<0.05)。结论:超声引导下细针穿刺病理检查对甲状腺结节良恶性鉴别及病理分型均体现较高临床价值;高质量样本有助于提高细针穿刺诊断结节良恶性的特异性、敏感性和准确性,最大直径、钙化是穿刺标本质量的影响因素。Objective:To explore the value of ultrasound-guided fine needle aspiration biopsy in differentiating benign from malignant thyroid nodules,and to analyze the influencing factors of the quality of puncture specimens.Methods:The clinical data of 577 patients who underwent fine needle aspiration biopsy of thyroid nodules in our hospital from January 2017 to December 2021 were collected.Among them,79 patients(100 nodules)underwent thyroid surgery and obtained histopathological results.The diagnostic value of ultrasound-guided fine needle aspiration biopsy of thyroid nodules was analyzed,and the influencing factors of specimen quality were analyzed by binary logistics regression coefficient.Results:The sensitivity,specificity and accuracy of fine needle biopsy were 98.48%,91.18%and 96.00%respectively.The consistency analysis of the pathological classification results of fine needle puncture biopsy and histological pathological examination showed that the Kappa value was 0.914,which was almost identical(P<0.05).Compared with the non-excellent group,the sensitivity,specificity and accuracy of diagnosis in the excellent group were higher(P<0.05).Compared with the good diagnosis group,the proportion of>1 cm in the non-good diagnosis group was less,and the proportion of calcification was more(P<0.05).The number of cells in the excellent group was more sufficient, and the preparation effect of cell wax block was better,binary logistics regressionanalysis showed that the maximum diameter and calcification were important factors affecting the quality of fineneedle puncture specimens ( P < 0. 05) . Conclusion: Ultrasound - guided fine needle aspiration biopsy has highclinical value in differentiating benign from malignant thyroid nodules and pathological classification. High - qualitysamples are helpful to improve the specificity, sensitivity and accuracy of fine needle aspiration in the diagnosis ofbenign and malignant nodules. The maximum diameter and calcification are the influencing factors of the quality ofpuncture sample

关 键 词：甲状腺结节 良恶性 超声引导下 细针穿刺病理检查 鉴别价值 影响因素 

分 类 号：R736.1[医药卫生—肿瘤]