B超联合细针穿刺细胞病理学在评价甲状腺结节中的应用

摘要
图/表
参考文献
相关文章 (0)

全文: PDF (1319 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：探讨超声联合细针穿刺细胞病理学（FNA）在诊断甲状腺结节中的价值。方法：回顾性分析2010年2月至2014年7月甲状腺手术病例2 491例，其中甲状腺癌249例，分析其甲状腺B超和FNA的特点，前者包括甲状腺体积的大小、结节的多少和大小、回声以及边缘情况、微钙化状况、纵横比失调情况，后者包括核沟和核内包涵体、玻璃样染色质和乳头状结构。分析甲状腺B超和FNA单独及联合诊断甲状腺癌的敏感性和特异性。结果：甲状腺B超提示恶性的单个指标分别是结节内微钙化、单个结节大于2 cm和纵横比失调，但是不能直接判定良恶性。FNA诊断甲状腺癌的敏感性和特异性分别为88%和77%。超声联合FNA的诊断敏感性和特异性为71%和96%。结论：在术前鉴别甲状腺结节的良恶性方面，B超联合FNA仍是一线的经济有效的检测方法。

	服务
	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	龚伟1
	方伟建1
	陈国荣2
	冯娅琴3

关键词 ：甲状腺肿瘤；超声检查, 多普勒；活组织检查, 针吸；细胞病理学

Abstract：Objective: To explore the application of ultrasonography combined with fine-needle aspiration (FNA) cytopathology on evaluating thyroid nodules. Methods: A total of 2 491 cases of thyroid surgery, of whom 249 cases were malignant from 2010 February to 2014 July were analyzed retrospectively, including the characteristics of ultrasonography and FNA cytopatholgoy. The former consisted of thyroid’s volume, number, size, hypoechogenecity, blur margin, microcalcification and taller-than-wide shape of thyroid nodule, the later included nuclear grooves, pseudoinclusions, ground glass and papillary architecture. Results: The single marker in thyroid ultrasonography related with malignancy was nodular microcalcification, single nodule larger than 2 cm and taller-than-wide nodule (all P<0.05), but all of which couldn’t tell the nature of thyroid nodules. The diagnostic sensitivity and specificity of FNA cytopathology on thyroid cancer was 88% and 77%, and the combination of ultrasonography and FNA cytopathology was 71% and 96%. Conclusion: In this regard of distinguishing the difference of benign and malignant nodule of thyroid, ultrasonography combined with FNA cytopathology is the first line and cost-effective evaluation method.

Key words： thyroid neoplasms ultrasonography, doppler biopsy, needle cytopatholgoy

收稿日期: 2015-01-15

通讯作者: 陈国荣，教授，主任医师，硕士生导师，Email：chen gr1978@aliyun.com。

作者简介: 龚伟（1973-），男，浙江义乌人，副主任医师。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2015/V45/I9/690

[1] Zhao L, Gong Y, Wang J, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid bed lesions from patients with thyroidectomy for thyroid carcinomas[J]. Cancer Cytopathol, 2013, 121(2): 101-107.
[2] Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule size and prediction of cancer[J]. J Clin Endocrinol Metab, 2013,98(2): 564-570.
[3] Lim DJ, Kim JY, Baek KH, et al. Natural course of cytologically benign thyroid nodules: observation of ultrasono-graphic changes[J]. Endocrinol Metab, 2013, 28(2): 110-118.
[4] Yoon JH, Kwak JY, Moon HJ, et al. The diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy and the sonographic differences between benign and malignant thyroid nodules 3cm or larger[J]. Thyroid, 2011, 21(9): 993-1000.
[5] Kim JY, Kim SY, Yang KR. Ultrasonographic criteria for fine needle aspiration of nonpalpable thyroid nodules 1-2cm in diameter[J]. Eur J Radiol, 2013, 82(2): 321-326.
[6] Azar N, Lance C, Nakamoto D, et al. Ultrasonographic thyroid findings suspicious for malignancy[J]. Diagn CytoPathol, 2013, 41(12): 1107-1114.
[7] Grani G, Calvanese A, Carbotta G, et al. Intrinsic factors affecting adequacy of thyroid nodule fine-needle aspiration cytology[J]. Clin Endocrinol, 2013, 78(1): 141-144.
[8] Witt BL, Schmidt RL. Rapid onsite evaluation improves the adequacy of fine-needle aspiration for thyroid lesions: a systematic review and meta-analysis[J]. Thyroid, 2013, 23(4): 428-435.
[9] Lupo MA. Thyroid nodule evaluation: US-FNA and on-site cytology assessment[J]. Endocr Pract, 2013, 19(4): 732-734.
[10] Zanocco K, Pitelka-zengou L, Dalal S, et al. Routine on-site evaluation of specimen adequacy during initial ultrasound-guided fine needle aspiration of thyroid nodules: a cost-effectiveness analysis[J]. Ann Surg Oncol, 2013, 20(8): 2462-2467.
[11] Tee YY, Lowe AJ, Brand CA, et al. Fine-needle aspiration may miss a third of all malignancy in palpable thyroid nodules a comprehensive literature review[J]. Ann Surg,2007, 246(5): 714-720.
[12] Moon HJ, Kim EK, Kwak JY. Malignancy risk stratification in thyroid nodules with benign results on cytology: combination of thyroid imaging reporting and data system and bethesda system[J]. Ann Surg Oncol, 2014, 21(6): 1898-1903.
[13] Yoo WS, Choi HS, Cho SW, et al. The role of ultrasound findings in the management of thyroid nodules with atypia or follicular lesions of undetermined significance[J]. Clin Endocrinol, 2014, 80(5): 735-742.
[14] Cesur M, Corapcioglu D, Bulut S, et al. Comparison of palpation-guided fine-needle aspiration biopsy to ultrasound-guided fine-needle aspiration biopsy in the evaluation of thyroid nodules[J]. Thyroid, 2006, 16(6): 555-561.
[15] 施秉银, 赵媛. 甲状腺细针抽吸细胞学检查及临床应用评价[J]. 中华内分泌代谢杂志, 2004, 20(2): 180-182.
[16] 邵清, 邹大中, 周斌, 等. 超声造影联合细针穿刺在甲状腺结节诊断中的意义[J]. 实用临床医药杂志, 2011, 15(17): 77-79.
[17] Lin JD, Chao TC, Huang BY, et al. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine-needle aspiration cytology[J]. Thyroid, 2005, 15(7): 708-717.
[18] Kim DW, Jung SJ, Eom JW, et al. Color doppler features of solid, round, isoecholic thyroid nodules without malignant sonographic features: a prospective cytopathological study [J]. Thyroid, 2013, 23(4): 472-476.
[19] Gharib H, Goellner JR. Fine needle aspiration biopsy of the thyroid: an appraisal[J]. Ann Intern Med, 1993, 118(4): 282-289.
[20] Orlandi A, Puscar A, Capriata E, et al. Repeated fine-needle aspiration of the thyroid in benign nodular thyroid disease: critical evaluation of long-term follow-up[J]. Thyroid, 2005,15(3): 274-278.