超声引导甲状腺结节细针穿刺抽吸活检Bethesda Ⅰ类标本的影响因素分析  

Analysis of impact factors of ultrasound guided-fine needle aspiration biopsy for BethesdaⅠof thyroid nodules

作　　者：何珂 王东林[1] 廖卫[1] 罗才顺 HE Ke;WANG Dong-lin;LIAO Wei;LUO Cai-shun(Hainan General Hospital,Hainan Affiliated Hospital of Hainan Medical University,Haikou 57031l,China)

机构地区：[1]海南省人民医院,海南医学院附属海南医院,海南海口570311

出　　处：《中国临床医学影像杂志》2024年第8期545-548,562,共5页Journal of China Clinic Medical Imaging

基　　金：海南省自然科学基金高层次人才(项目编号:821RC755)。

摘　　要：目的:探讨甲状腺结节行超声引导下细针穿刺抽吸活检(US-FNAB)细胞病理学Bethesda Ⅰ类(不能诊断)标本的主要影响因素,旨在提升US-FNAB获取甲状腺结节标本的质量,提高病理诊断的准确性。方法:回顾性选取我院超声科行甲状腺结节US-FNAB患者245例,共250个结节,根据甲状腺细胞病理学Bethesda报告系统(TBSRTC)分为6类,其中Bethesda Ⅰ类为非诊断性(38个),BethesdaⅡ~Ⅵ类判定为标本可以诊断(212个),比较结节最大直径、位置、边界、内部结构、回声类型、生长方式、钙化情况、血供情况及是否处于特殊部位、是否靠近前或后被膜、操作者是否用穿刺针抽吸细胞保存液冲刷针头,分析影响US-FNAB标本TBSRTC诊断Ⅰ类的影响因素。结果:甲状腺结节处于特殊部位(结节贴近颈动脉、气管两侧或食管)与非特殊部位、且在处于特殊部位的结节中,最大直径≤10mm与最大直径>10mm结节间TBSRTC诊断Ⅰ类与Ⅱ~Ⅵ类间差异有统计学意义(P<0.05);另外,在取样次数为4~6次的前提下,穿刺后穿刺针未抽吸液体与抽吸液体冲刷针头之间TBSRTC诊断Ⅰ类与Ⅰ~Ⅵ类差异有统计学意义(P<0.05)。结论:甲状腺结节贴近颈动脉、气管两侧或食管是TBSRTC诊断Ⅰ类的主要影响因素,且最大直径≤10mm比最大直径>10mm结节更容易获得BethesdaⅠ类诊断;在取样次数相同的前提下,穿刺后穿刺针未抽吸液基瓶中细胞保存液冲刷针头也是TBSRTC诊断Ⅰ类的主要影响因素。Objective:To explore the main influencing factors of thyroid nodule ultrasound guided-fine needle aspiration biopsy(US-FNAB)cytopathology Bethesda Type I(undiagnosable)specimens,with a view to improving the quality of thyroid nodule specimens obtained by US-FNAB and improving the accuracy of pathological diagnosis.Methods:A total of 250 thy-roid nodules in 245 patients with US-FNAB and according to The Bethesda System for Reporting Thyroid Cytopathology(TB-SRTC)divided into 6 categories,of which the Bethesda Ⅰ category without diagnostic availability and the Bethesda Ⅱ~Ⅵ categories were judged to be diagnosable,the maximum diameter,location,boundary,internal structure,internal echo,growth pattern,calcification,blood supply and whether it was in a special position,near the anterior or posterior capsule and whether the operator washes the needle with the liquid in the liquid-based botle after the puncture were compared,the influencing factors of TBSRTC diagnosis Ⅰ category in US-FNAB specimens were analyzed.Results:The thyroid nodule was located at a specific site(adjacent to the carotid artery,trachea,or esophagus)and without located at a specific site,located at a specific site with the largest diameter≤10 mm and the largest diameter>10 mm,there were significant difference between TBSRTC diagnosis Ⅰ and Ⅱ~Ⅵ category(P<0.05).In addition,on the premise of 4~6 sampling times,washes the needle with the liq-uid and non-washes after the puncture was significant difference between TBSRTC diagnosis Ⅰ and Ⅱ~Ⅵ category(P<0.05).Conclusion:In the diagnosis of TBSRTC Ⅰ category,the thyroid nodules proximity of the carotid artery,trachea,or esopha-gus is a major influencing factor,and the maximum diameter≤10 mm than the maximum diameter>10 mm nodule was more readily obtained the Bethesda Ⅰ category.Under the condition of the same sampling times,non-washes the needle with the liquid after the puncture was also the main influencing factor.

关 键 词：甲状腺结节 超声检查 多普勒 彩色 

分 类 号：R581[医药卫生—内分泌] R445.1[医药卫生—内科学]