细针穿刺细胞学在C-TIRADS 4类甲状腺结节合并桥本甲状腺炎中的诊断价值  

Value of Fine-Needle Aspiration Cytology in the Diagnosis of C-TIRADS 4 Thyroid Nodules Complicated with Hashimoto's Thyroiditis

作　　者：王萍萍 张永生 张立平 高萍 崔久栋 张文振 WANG Pingping;ZHANG Yongsheng;ZHANG Liping;GAO Ping;CUI Jiudong;ZHANG Wenzhen(Rizhao Central Hospital,Rizhao 276800,China)

机构地区：[1]日照市中心医院,山东日照276800

出　　处：《肿瘤学杂志》2025年第2期122-127,共6页Journal of Chinese Oncology

摘　　要：[目的]探讨超声引导下细针穿刺细胞学(fine needle aspiration cytology,FNAC)检查在中国甲状腺影像报告和数据系统(Chinese-Thyroid Imaging Reporting and Data System,C-TIRADS)4类甲状腺结节合并桥本甲状腺炎(Hashimoto’s thyroiditis,HT)中的诊断价值。[方法]选取2020年6月至2023年12月于日照市中心医院行FNAC的甲状腺结节病例1142例(伴HT 579例,不伴HT 563例)。所有患者均行二维超声检查提示甲状腺结节C-TIRADS 4类。比较FNAC对HT(+)组和HT(-)组的诊断效能。[结果]HT(+)组579例结节中,BethesdaⅡ类77例(13.3%),Ⅲ类162例(28.0%),Ⅳ类6例(1.0%),Ⅴ类130例(22.5%),Ⅵ类204例(35.2%)。HT(-)组563例结节中,BethesdaⅡ类82例(14.6%),Ⅲ类101例(17.9%),Ⅳ类11例(2.0%),Ⅴ类121例(21.5%),Ⅵ类248例(44.0%)。HT(+)组甲状腺结节FNAC阳性率显著低于HT(-)组(57.7%vs 65.5%,P=0.006)。HT(+)组FNAC的灵敏度为78.6%,特异度为95.4%,准确率为81.5%;HT(-)组FNAC的灵敏度为87.2%,特异度为98.1%,准确率为88.4%;HT(+)组患者FNAC灵敏度和准确率低于HT(-)组,差异有统计学意义(P=0.001,P=0.002)。[结论]FNAC是甲状腺结节诊断的有效手段,在C-TIRADS 4类甲状腺结节中特异度高,但合并HT降低了诊断的灵敏度和准确率。[Objective]To investigate the value of ultrasound-guided fine needle aspiration cytology(FNAC)in the diagnosis of C-TIRADS 4 thyroid nodules complicated with Hashimoto's thyroiditis(HT).[Methods]A total of 1142patients who underwent two-dimensional ultrasonography and FNAC in Rizhao Central Hospital from June 2020 to December 2023 and indicating C-TIRADS 4 thyroid nodules were enrolled in the study,including 579 cases with HT and 563 cases without HT.The diagnostic performance of FNAC was evaluated.[Results]Among the 579 nodules in the HT(+)group,there were 77 cases(13.3%)of Bethesda classⅡ,162 cases(28.0%)of classⅢ,6 cases(1.0%)of classⅣ,130 cases(22.5%)of classⅤ,and 204 cases(35.2%)of classⅥ.Among the 563 nodules in the HT(-)group,there were 82 cases(14.6%)of classⅡ,101 cases(17.9%)of classⅢ,11 cases(2.0%)of classⅣ,121 cases(21.5%)of classⅤ,and 248 cases(44.0%)of classⅥ.The positive rate of thyroid nodule for FNAC in the HT(+)group was significantly lower than that in the HT(-)group(57.7%vs 65.5%,P=0.006).The sensitivity,specificity and accuracy of FNAC in the HT(+)group were 78.6%,95.4 and 81.5%,respectively.The sensitivity,specificity and accuracy of FNAC in the HT(-)group were 87.2%,98.1%and 88.4%,respectively.The sensitivity and accuracy of FNAC in the HT(+)group were lower than those in the HT(-)group(P=0.001,P=0.002).[Conclusion]FNAC is an effective method for the diagnosis of thyroid nodules,and has high specificity in C-TIRADS 4 thyroid nodules;however,the presence of HT reduces its sensitivity and accuracy of diagnosis.

关 键 词：甲状腺结节 细针穿刺细胞学 C-TIRADS 4 桥本甲状腺炎 

分 类 号：R736.1[医药卫生—肿瘤]