超声引导下重复细针穿刺活检术对BethesdaⅢ类甲状腺结节临床管理的影响  

Impact of ultrasound-guided repeated fine-needle aspiration biopsy on the clinical management of BethesdaⅢthyroid nodules

作　　者：张帅[1] 付庆锋[1] 何润东 孙平 孙辉[1] 周乐[1] Zhang Shuai;Fu Qingfeng;He Rundong;Sun Ping;Sun Hui;Zhou Le(Department of Thyroid Surgery,China-Japan Union Hospital of Jilin University,Jilin Provincial Key Laboratory of Translational Medicine of Surgery,Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Treatment,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院甲状腺外科、吉林省外科转化医学重点实验室、吉林省甲状腺疾病防治工程实验室,长春130033

出　　处：《中华内分泌外科杂志（中英文）》2024年第4期489-493,共5页Chinese Journal of Endocrine Surgery

基　　金：吉林省财政厅项目(2019SCZ029)。

摘　　要：目的研究超声引导下细针穿刺细胞学检查(fine-needle aspiration biopsy,FNAB)为BethesdaⅢ类甲状腺结节重复细针穿刺细胞学检查(repeated fine-needle aspiration biopsy,rFNAB)的时机及特征,并进一步优化穿刺方案。方法回顾性分析中日联谊医院甲状腺外科2020年12月至2022年12月初次FNAB结果为BethesdaⅢ类,行rFNAB的71例(73枚结节)患者资料,女57例,男14例,年龄(45.7±10.4)岁。按照rFNAB结果将结节进行分组,BethesdaⅡ为良性组21枚、BethesdaⅤ/Ⅵ为恶性组39枚,以上两组统划为诊断明确组,其余分类为非明确诊断组13枚。记录rFNAB结果、穿刺间隔时间、术后病理、超声特征、FNAB特征等。计数资料用百分比和数字表示,计量资料用平均数±标准差(±s)表示,应用χ2检验或Fisher精确检验等统计方法分析。结果本研究对73枚BethesdaⅢ类甲状腺结节进行了rFNAB,结果显示60枚(82.2%)结节得到明确诊断,13枚(17.8%)结节未非明确诊断。恶性组的钙化特征与良性组、非诊断组之间差异具有统计学意义(P<0.05)。在恶性组中,29例接受手术治疗,初次FNAB后间隔时间超过3个月再手术治疗的患者中仅2例(8.0%),复发风险为中危。重新审查rFNAB恶性组的31个初次穿刺样本,其中9个(29%)镜下细胞轻度异型,22个(71.0%)取材不良,多以纤维及钙化成分为主。结论初次FNAB为BethesdaⅢ类的结节在超过3个月随访后,新增或持续存在可疑超声征象尤其是存在微钙化征象时应行rFNAB,但穿刺时应针对结节边缘非钙化区进行多点穿刺,以提高rFNAB的准确性和可靠性。ObjectiveTo investigate the timing and features of fine-needle aspiration biopsy(FNAB)guided by ultrasound for BethesdaⅢthyroid nodules and to further optimize the puncture scheme.MethodsA retrospective analysis was conducted on data from patients who underwent rFNAB for BethesdaⅢthyroid nodules at the China-japan Union Hospital of Jilin University Thyroid Surgery Department from Dec.2020 to Dec.2022.The study included 71 cases(73 nodules),consisting of 57 females and 14 males,with an average age of(45.7±10.4)years.Patients were grouped based on rFNAB results:BethesdaⅡas the benign group(n=21),BethesdaⅤ/Ⅵas the malignant group(n=39),and the remaining cases categorized as the indeterminate group(n=13).Data on rFNAB results,puncture interval time,postoperative pathology,ultrasound features,and FNAB characteristics were recorded.Descriptive statistics were used for categorical data,presented as percentages and numbers,while continuous data were presented as mean±standard deviation(±s).Theχ2 test or Fisher's exact test was applied for analysis.ResultsIn this study,rFNAB was performed on 73 BethesdaⅢthyroid nodules.The results showed that 60 nodules(82.2%)received a definite diagnosis,while 13 nodules(17.8%)were indeterminate.There was a statistically significant difference in the calcification classification between the malignant group and the benign group as well as the indeterminate group(P<0.05).Among the malignant group,29 patients underwent surgical treatment,with only 2 cases(8.0%)showing intermediate recurrence risk when surgery was performed more than three months after the initial FNAB.Upon reevaluation of the 31 initial FNAB samples from the malignant group,9 samples(29.0%)exhibited mild cytological atypia,and 22 samples(71.0%)had poor quality specimens,mainly comprising fibrous and calcified components.ConclusionsFor nodules initially classified as BethesdaⅢ,if suspicious ultrasound features persist or emerge,especially if microcalcifications are present,rFNAB should be performed after a

关 键 词：甲状腺结节 细针穿刺细胞学检查 

分 类 号：R581[医药卫生—内分泌]