车娜, 孙保存, 刘增辉, 赵秀兰, 倪春生. 1 241例甲状腺结节US-FNAB病例临床特点与病理结果分析[J]. 中国肿瘤临床, 2018, 45(7): 350-354. DOI: 10.3969/j.issn.1000-8179.2018.07.381
引用本文: 车娜, 孙保存, 刘增辉, 赵秀兰, 倪春生. 1 241例甲状腺结节US-FNAB病例临床特点与病理结果分析[J]. 中国肿瘤临床, 2018, 45(7): 350-354. DOI: 10.3969/j.issn.1000-8179.2018.07.381
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Che Na, Sun Baocun, Liu Zenghui, Zhao Xiulan, Ni Chunsheng. The clinical characteristics and pathological results of the thyroid nodules by US-FNAB: a study of 1,241 cases[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2018, 45(7): 350-354. DOI: 10.3969/j.issn.1000-8179.2018.07.381
Citation: Che Na, Sun Baocun, Liu Zenghui, Zhao Xiulan, Ni Chunsheng. The clinical characteristics and pathological results of the thyroid nodules by US-FNAB: a study of 1,241 cases[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2018, 45(7): 350-354. DOI: 10.3969/j.issn.1000-8179.2018.07.381
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1 241例甲状腺结节US-FNAB病例临床特点与病理结果分析

The clinical characteristics and pathological results of the thyroid nodules by US-FNAB: a study of 1,241 cases

    摘要
  • 摘要:
      目的  探讨超声引导下细针穿刺活检（ultrasound guided fine needle aspiration biopsy，US-FNAB）对甲状腺结节的诊断价值。
      方法  回顾性分析天津医科大学总医院2016年1月至2017年4月行US-FNAB检查的甲状腺结节患者的临床特点及细胞病理诊断结果，对细胞诊断结果和手术病理结果进行对照分析。
      结果  在1 241例病例中，甲状腺结节男女比1 :3.83（257/984），甲状腺结节的发病率从20岁开始逐年增加，60岁以后发病率开始下降。肿瘤最大径≤1.0 cm的结节640例（51.57%），TI-RADS 4级的结节1 072例（86.38%）。细胞学诊断结果中无法诊断的病例273例（22.00%），良性121例（9.75%），意义不明确的细胞非典型病变380例（30.62%），可疑恶性399例（32.15%），恶性68例（5.48%）。其中在天津医科大学总医院行手术的302例患者中，US-FNAB细胞病理有明确诊断203例，无法诊断21例，意义不明确的细胞非典型病变78例。203例明确诊断的病例中，US-FNAB诊断的灵敏度为100.00%（201/201），特异度为50.00%（1/2），阳性预测值99.50%（201/202），阴性预测值100.00%（1/1），诊断的准确率99.51%（202/ 203），误诊率0.49%（1/203）。在细胞学诊断为意义不明确的细胞非典型病变的78例中，恶性率70.51%。意义不明确细胞非典型病变是否为恶性与患者的年龄、性别、肿瘤大小和部位均无关（均P＞0.05），与甲状腺超声影像报告和数据系统（thyroid imaging re-porting and data system，TI-RADS）分级有关（P＜0.05）。
      结论  US-FNAB对甲状腺结节有较高的诊断价值，值得推广应用，可以考虑部分代替术中冰冻，减少术中等候时间和患者的经济负担。

     

    Abstract:
      Objective  To explore the diagnostic value of ultrasound-guided fine needle aspiration biopsy (US-FNAB) for thyroid nodules.
      Methods  The clinical characteristics and cytopathological diagnosis of patients with thyroid nodules in Tianjin Medical University General Hospital were analyzed retrospectively; the results of the cytopathological and pathological diagnoses were compared and analyzed.
      Results  Of the 1, 241 US-FNAB samples, the ratio of men to women with thyroid nodules was 1:3.83 (257/984). The incidence of thyroid nodules gradually increased from the age of 20 years and declined after the age of 60 years. The nodules, which were less than or equal to 1.0 cm in size, accounted for 51.57%(640 cases), and Thyroid Imaging Reporting And Data System (TIRADS) classification 4 accounted for 86.38% (1 072 cases). Of cyto-pathological diagnoses, 22.00% (273 cases) were non-diagnostic, 9.75% (121 cases) were benign, 30.62% (380 cases) were atypia with undetermined significance, 32.15% (399 cases) were suspicious for malignancy, and 5.48% (68 cases) were malignant. In the 302 patients who underwent surgery, the number of cases of clear diagnoses, unavailable diagnoses, and atypia of undetermined significance were 203, 21, and 78, respectively. In the 203 cases of clear diagnoses, the sensitivity, specificity, positive predictive value, negative predictive value, precision, and misdiagnoses following US-FNAB of thyroid nodules were 100.00% (201/201), 50.00% (1/2), 99.50% (201/202), 100.00% (1/1), 99.51% (202/203), and 0.49% (1/203), respectively. In the 78 cases that were atypia of undetermined significance, the malignancy rate was 70.51%. Whether the atypia of undetermined significance was malignant or not was related to the TIRADS classification (P < 0.05), and not related to the age, sex, tumor size, or location of the nodules (P > 0.05).
      Conclusions  US-FNAB has high diagnostic value for thyroid nodules and is worthy of being popularized widely. If it replaced some intra-operative frozen sectioning procedures, it may reduce intra-operative waiting time and financial burden of patients.

     

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