超声引导下甲状腺结节活检3种方法的对比研究  

A comparative study of three methods of ultrasound-guided biopsy of thyroid nodules

作　　者：汤四新[1] 张迅 乐坚 周世崇 

机构地区：[1]江苏省泰州市第四人民医院超声科,江苏泰州225300 [2]复旦大学附属肿瘤医院超声科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《肿瘤影像学》2016年第3期263-266,共4页Oncoradiology

基　　金：国家自然科学基金(No:81401422)

摘　　要：目的:探讨超声引导下甲状腺结节活检3种方法的优缺点及临床应用价值。方法:选择在复旦大学附属肿瘤医院就诊,超声检查为甲状腺结节者178例,其中A组55例行超声引导下18G粗针穿刺组织学检查,B组61例行超声引导下21G细针穿刺组织学检查,C组62例行超声引导下穿刺抽吸细胞学检查。将其中72例手术患者的术前穿刺病理诊断结果与术后组织病理学结果比较。结果:72例手术治疗患者中,A组28例粗针穿刺病理结果显示甲状腺乳头状癌19例、甲状腺滤泡癌1例、结节样甲状腺肿7例、桥本病1例,与手术病理比较诊断符合率96.43%(27/28);B组21例21G细针穿刺病理结果显示甲状腺乳头状癌15例、结节样甲状腺肿4例、甲状腺腺瘤1例、亚甲炎1例,与手术病理比较诊断符合率95.24%(20/21)。C组23例细胞学活检病理显示甲状腺乳头状癌12例、结节样甲状腺肿6例、甲状腺腺瘤3例、桥本病1例、亚甲炎1例,与手术病理比较诊断符合率82.61%(19/23)。178例穿刺患者中,A组出血形成局部血肿14例,1例形成假性动脉瘤;B组出血形成局部血肿1;C组无1例并发症。结论:粗针活检与细针活检的诊断率相近,但粗针活检的并发症发生率明显高于细针活检。细胞学活检诊断准确率低于穿刺组织学病理,优点是无并发症,且可引导从多角度、多方位进针。Objective: To explore the advantages and disadvantages of three methods of thyroid nodule biopsy under ultrasound guidance and the clinical application value. Methods: A total of 178 cases of thyroid nodules from Fudan University Shanghai Cancer Center were examined by ultrasound. In group A, 55 cases were examined by ultrasound-guided 18 G needle biopsy for histological examination. In group B, 61 cases underwent ultrasound-guided fine needle biopsy using 21 G needle. In group C, 62 cases underwent ultrasound-guided aspiration biopsy cytology. The results of preoperative and postoperative pathological diagnosis of 72 cases with surgery were compared. Results: In group A, 19 cases had papillary thyroid carcinoma, 1 case had follicular carcinoma, 7 cases had nodular goiter and 1 case had Hashimoto’s thyroiditis. Compared with the surgical pathology, the diagnostic accordance rate was 96.43%(27/28). In group B, 15 cases had papillary thyroid carcinoma, 4 cases had nodular goiter, 1 case had thyroid adenoma and 1 case had subacute thyroiditis. Compared with the surgical pathology, the diagnostic accordance rate was 95.24%(20/21). In group C, 6 cases had nodular goiter, 3 cases had thyroid adenoma, 1 case had Hashimoto’s thyroiditis and 1 case had subacute thyroiditis. Compared with the surgical pathology, the diagnostic accordance rate was 82.61%(19/23). In group A, bleeding hematoma was found in 14 cases, and false aneurysm formation in one case. In group B, bleeding hematoma was found in one case. There were no complications in group C. Conclusion: The diagnostic rates of needle biopsy and fine needle biopsy are similar but the complication incidence of thick needle biopsy is significantly higher than that of fine needle biopsy. The diagnostic accuracy of biopsy cytology is lower than that of puncture biopsy, but it has the advantages of no complications and being guided from multi angle and multi direction.

关 键 词：甲状腺 超声 穿刺 

分 类 号：R445.1[医药卫生—影像医学与核医学] R581[医药卫生—诊断学]