术中冰冻切片在诊断甲状腺结节不同细胞学类别中的价值

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1286 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的：探讨术中冰冻切片（FS）对术前超声引导下细针穿刺（FNA）细胞学检查Bethesda不同类别甲状腺结节的诊断价值。方法：回顾性分析从2011年1月至2013年2月间在浙江大学医学院附属第二医院行甲状腺外科手术治疗并经常规病理证实的881个甲状腺结节的资料，所有结节术前行超声引导下FNA检查，术中行甲状腺结节FS检查。FNA的结果参照甲状腺细胞病理学Bethesda分类法，分为6类，分别分析术中FS在细胞学不同类别中的诊断准确性。结果：881个结节中，Bethesda I类57个（占6.47%），其中恶性32个，占56.14%（32/57），FS诊断准确率为91.23%（52/57）；Bethesda II类95个（占10.78%），其中恶性36个，占37.89%（36/95），FNA诊断准确率为62.11%（59/95），FS切片诊断准确率为90.53%（86/95）；Bethesda III、IV类共65个（占7.38%），其中恶性32个，占49.23%（32/65），FNA诊断准确率50.77%（33/65），FS诊断准确率为87.69%（57/65）；Bethesda V、VI类共664个（75.37%），其中恶性646个，FNA诊断准确率97.29%（646/664），FS诊断准确率为91.42%（607/664）。FS在甲状腺细胞学Bethesda III、IV类的准确率相对较低，在Bethesda II
类准确率明显高于FNA的诊断准确率（P＜0.05），虽然在Bethesda V、VI类的准确率最高，但仍然低于FNA细胞学的诊断准确率（P＜0.05）。结论：超声引导下FNA检查对于细胞学Bethesda V、VI类的结节具有较高的诊断准确率，术中可不必行FS检查。而对于Bethesda I、II、III、IV类的结节，仍需结合FS指导临床治疗。

	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
	骆洁丽
	陈建设
	孙杨
	黄品同

关键词 ：超声检查, 细针穿刺, 冰冻超薄切片术, 甲状腺结节

Abstract：Objective: To investigate the diagnostic value of intra-operative frozen section (FS) in thyroid nodules with a prior ultrasound-guided fine needle aspiration (FNA) diagnosis of different Bethesda Categories. Methods: Eight hundred and eighty one nodules from January 2011 to February 2013 were retrospective analyzed in the Second Affiliated Hospital of Zhejiang University School of Medicine. All nodules had undergone both preoperative FNA examination and intra-operative FS examination. FNA cytologic diagnosis was classified into six categories based on the Bethesda system and the diagnostic accuracy of intra-operative FS was analysed in different categories of cytology. Results: Among 881 thyroid nodules 57 (6.47%) were classified as Bethesda Category I, 95 (10.78%) were classified as Bethesda Category II, 65 (7.38%) were classified as Bethesda Category III, IV, 664 (75.37%) were classified as Bethesda Category V, VI. 56.14% (32/57) of Bethesda Category I were histologically diagnosed as malignant, the precision of FS was 91.23%, 37.89% (36/95) of Bethesda Category II were histologically diagnosed as malignant and the precision of FS and FNA were 90.53% and 62.11% respectively, 49.23% (32/65) of Bethesda Category III, IV were histologically diagnosed as malignant, the precision of FS and FNA were 87.69% and 50.77% respectively, 97.29% (646/664) of Bethesda Category V and VI were histologically diagnosed as malignant, the precision of FS and FNA was 91.42% and 97.29% respectively. FS diagnosis was more accurate than FNA diagnosis in Bethesda Category II, III, IV, especially in Bethesda Category II (P<0.05), while the accuracy of FNA diagnosis in Bethesda Category V, VI was increasing obviously. The accuracy rate for dedection of malignancy by FNA was higher compared with the precision of FS in those categories (P<0.05). Conclusion: FNA was an accurate method for evaluating thyroid nodules in Bethesda Category V and VI, while FS do not seem to be necessary in those nodules. Intra-operative FS could be avoided when the FNA results were classified as Bethesda Category V and VI, while FS was most helpful when FNA results are Bethesda Category I, II, III, IV, which may increase the diagnostic accuracy of thyroid nodules and guide clinical treatment well.

Key words： ultrasonography fine needle aspiration cryoultramicrotomy thyroid nodule

收稿日期: 2016-04-25

基金资助:国家自然科学基金国际（地区）合作与交流项目（81271584）。

通讯作者: 黄品同，主任医师，博士师导师，Email：huangpintong@126.com。

作者简介: 骆洁丽（1991-），女，浙江绍兴人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I3/211

[1] FEI X F, YANG D X, KONG Z, et al. Thyroid cancer incidence in China between 2005 and 2009[J]. Stoch Environ Res Risk Assess, 2014, 28(5): 1075-1082.
[2] 赵剑, 罗天航, 丁三, 等. 甲状腺癌切除术后甲状腺功能变化的临床观察[J]. 中国临床医生杂志, 2014, 42(10): 57-58.
[3] 龚伟, 方伟建, 陈国荣, 等. 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[J]. 温州医科大学学报, 2015, 45(9): 690-693.
[4] AKHTAR S, AWAN M S. Role of fine needle aspiration and frozen section in determining the extent of thyroidectomy[J]. Eur Arch Otorhinolaryngol, 2007, 264(9): 1075-1079.
[5] MOON H J, KIM E K, KWAK J Y. 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.
[6] 刘友忠, 于洋, 赵翠, 等. 甲状腺乳头状癌合并桥本甲状腺炎的临床生物学特性分析[J]. 中华普通外科杂志, 2013, 28(4): 256-258.
[7] 叶昀亮, 项颖颖, 郑华敏, 等. 甲状腺乳头状癌合并桥本病的超声及临床病理特征[J]. 温州医学院学报, 2013, 43(12): 771-774.
[8] FURLAN J C, BEDARD Y C, ROSEN I B. Role of fineneedle aspiration biopsy and frozen section in the management of papillary thyroid carcinoma subtypes[J]. World J Surg, 2004, 28(9): 880-885.
[9] OSAMURA R Y, HUNT J L. Current practices in performing frozen sections for thyroid and parathyroid pathology[J].Virchows Arch, 2008, 453(5): 433-440.
[10] LIVOLSI V A, BALOCH Z W. Use and abuse of frozen section in the diagnosis of follicular thyroid lesions[J]. Endocr Pathol, 2005, 16(4): 285-293.
[11] 张翠华. 甲状腺微小乳头状癌术中冰冻未能诊断的原因分析[J]. 世界最新医学信息文摘, 2015, 15(47): 136.
[12] LANITIS S, SOURTSE G, KOULOURA A, et al. Thyroid surgery: Does frozen section have a role? If yes, in which cases?[J]. Hell Cheirourgike, 2015, 87(1): 31-33.
[13] 庄晓泉, 苏柳. 甲状腺乳头状癌误诊原因分析[J]. 实用医学杂志, 2011, 27(5): 887-888.
[14] EL-BAHRAWY M, GANESAN R. Frozen section in gynaecology: uses and limitations[J]. Arch Gynecol Obstet, 2014, 289(6): 1165-1170.
[15] RICHARDS M L, CHISHOLM R, BRUDER J M, et al. Is thyroid frozen section too much for too little?[J]. Am J Surg,2002, 184(6): 510-514.
[16] SUNG J Y, NA D G, KIM K S, et al. Diagnostic accuracy of fine-needle aspiration versus core-needle biopsy for the diagnosis of thyroid malignancy in a clinical cohort[J]. Eur Radiol, 2012, 22(7): 1564-1572.
[17] IRKORUCU O, TASCILAR O, CAKMAK G K, et al. Frozen section and fine needle aspiration biopsy in thyroid surgery-needles and sections[J]. Indian J Surg, 2007, 69(4): 140-144.
[18] 赵蕾, 翟贺宁, 王存川. 甲状腺微小乳头状癌的术中冰冻病理诊断分析[J]. 广东医学, 2014, 35(17): 2697-2699.
[19] MOON H J, KWAK J Y, KIM E K, et al. The combined role of ultrasound and frozen section in surgical management of thyroid nodules read as suspicious for papillary thyroid carcinoma on fine needle aspiration biopsy: a retrospective study[J]. World J Surg, 2009, 33(5): 950-957.
[20] 刘森. 探讨术中冰冻病理在甲状腺微小乳头状癌中的应用[J]. 中外医疗, 2016, 35(9): 25-27.