细胞学、细胞块及二者联合对于甲状腺乳头状微小癌诊断效能比较  

Comparison of cytology,cell block and their combination in diagnosing papillary thyroid microcarcinoma

作　　者：潘傲楠 张洋[2] 高璐滢 安宇昂 夏宇 姜玉新 PAN Aonan;ZHANG Yang;GAO Luying;AN Yuang;XIA Yu;JIANG Yuxin(Department of Ultrasound,Peking Union Medical College HospitalChinese Academy of Medical SciencesPeking Union Medical College,Beijing100730,China;Department of Pathology,Peking Union Medical College HospitalChinese Academy of Medical SciencesPeking Union Medical College,Beijing100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院超声医学科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《中国医药导报》2025年第6期160-164,共5页China Medical Herald

基　　金：中央高水平医院临床科研专项项目(2022-PUMCH-B-066)。

摘　　要：目的比较细胞学、细胞块及二者联合对于甲状腺乳头状微小癌(PTMC)的诊断效能。方法纳入2020年6月至2023年6月于北京协和医院行甲状腺微小结节细针抽吸活检,以获取细胞学及细胞块进行穿刺病理诊断,并于北京协和医院接受手术治疗的154例(PTMC 125例,良性病变29例)患者。首先,计算术前细胞学及细胞块各诊断类型分布差异。其次,将细胞学、细胞块及二者联合诊断分别与“金标准”进行一致性检验分析。此外,分别计算细胞学、细胞块及二者联合在PTMC中的诊断效能,并用DeLong检验比较3种诊断方法曲线下面积(AUC)。结果细胞学与细胞块诊断一致102例(102/154,66.23%),二者诊断一致且符合术后病理94例(94/102,92.16%)。细胞学和细胞块与“金标准”一致性均一般(Kappa值分别为0.639、0.710),二者联合与“金标准”一致性良好(Kappa值为0.795)。细胞学灵敏度、特异度、阳性预测值及AUC分别为88.80%、82.76%、99.14%及0.858,细胞块分别为93.60%、79.31%、95.12%及0.865,二者联合分别为98.40%、75.86%、94.62%及0.871,3种诊断方法AUC比较,差异无统计学意义(P>0.05)。结论细胞学、细胞块及二者联合诊断对于PTMC均有较好的诊断效能,3种诊断方法诊断效能无显著差异。Objective To compare cytology cell block,and their combination in the diagnosis of papillary thyroid microcarcinoma(PTMC).Methods A total of 154 patients(125 cases of PTMC and 29 cases of benign lesions)who underwent fine needle aspiration biopsy of thyroid micronodules in Peking Union Medical College Hospital from June 2020 to June 2023 to obtain cytology and cell blocks for puncture pathological diagnosis and received surgical treatment in Peking Union Medical College Hospital were included.Firstly,the distribution differences of preoperative cytology and cell block diagnosis types were calculated.Secondly,the consistency of cytology,cell block,and their combined diagnosis with the“gold standard”was analyzed.In addition,the diagnostic efficacy of cytology,cell block and their combination in PTMC was calculated respectively,and the area under the curve(AUC)of the three diagnostic methods was compared by DeLong test.Results A total of 102 cases(102/154,66.23%)were consistent with the diagnosis of cytology and cell block,and 94 cases(94/102,92.16%)were consistent with the postoperative pathology.The consistency of cytology and cell block with the“gold standard”was general(Kappa values were 0.639 and 0.710,respectively),and the combination of the two was in good agreement with the“gold standard”(Kappa value was 0.795).The sensitivity,specificity,positive predictive value and AUC of cytology were 88.80%,82.76%,99.14%,and 0.858,respectively.The sensitivity,specificity,positive predictive value and AUC of cell block were 93.60%,79.31%,95.12%,and 0.865,respectively.The sensitivity,specificity,positive predictive value and AUC of cytology combined with cell block were 98.40%,75.86%,94.62%,and 0.871,respectively.There was no significant difference in AUC among the three diagnostic methods(P>0.05).Conclusion Although cytology,cell block and their combination showed good performance in diagnosing PTMC,there is no significant difference among the three diagnostic methods.

关 键 词：细胞块 甲状腺乳头状微小癌 细胞学 诊断 细针抽吸活检 

分 类 号：R445.1[医药卫生—影像医学与核医学]