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

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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

Received: 25 April 2016

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	LUO Jieli
	CHEN Jianshe
	SUN Yang
	HUANG Pintong.

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https://xb.wmu.edu.cn/EN/ OR https://xb.wmu.edu.cn/EN/Y2017/V47/I3/211

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