体检发现的甲状腺结节的临床病理研究

A clinical pathological study of thyroid nodules detected by physical examinations

目的探讨体检发现的甲状腺结节甲状腺细针穿刺细胞学（FNAC）检查结果与甲状腺超声检查、组织病理结果之间的关系，分析结节的病因，评估甲状腺癌发生的危险性及FNAC的临床诊断价值。方法分析体检发现的271例甲状腺结节患者甲状腺FNAC诊断结果，并与甲状腺超声检查、组织病理结果进行比较。结果（1）FNAC显示，恶性及可疑恶性病变分别为1．48％和5．90％，良性病变占78．60％，以甲状腺肿（29．15％）、桥本甲状腺炎（26．57％）、甲状腺腺瘤（15．13％）多见。（2）FNAC诊断结果与甲状腺超声检查结果比较，96例单发结节FNAC诊断为恶性、可疑恶性的百分比分别为3．12％、7．29％；137例多发结节恶性、可疑恶性的百分比分别为0．73％、6．57％。108例直径≤1．5cm结节恶性、可疑恶性的百分比分别为0．93％、7．41％；125例直径〉1．5cm结节恶性、可疑恶性的百分比分别为2．40％、6．42％。99例实性结节恶性、可疑恶性的百分比分别为2．02％、12．12％；85例囊实性或囊性结节恶性、可疑恶性的百分比分别为2．35％、2．35％。仅实性结节可疑恶性的百分比高于囊性或囊实性结节（P=0．013）。（3）24例FNAC结果与组织病理学结果比较，FNAC的诊断准确率75．00％，假阳性率25．00％，假阴性率0％。结论体检发现的甲状腺结节的主要病因是甲状腺肿、桥本甲状腺炎和甲状腺腺瘤；FNAC检查是鉴别良、恶性甲状腺结节的一种高准确率的可靠方法；甲状腺超声检查检出的单发、实性、大结节任何单一因素不足以增加甲状腺癌的预测性。

Objective To investigate the relation among the results of thyroid fine needle aspiration cytology（FNAC） , thyroid ultrasonography （US） and histopathologic diagnosis about the thyroid nodules detected by physical examination, meanwhile to analyze the etiopathogenesis of the nodules and to evaluate the risk of thyroid cancer and the clinical diagnostic value of FNAC. Methods The data of thyroid FNAC results of the thyroid nodules detected by physical examination in 271 cases were analyzed and compared with thyroid US and histopathologic diagnosis. Result （ 1 ） The FNAC results showed that the incidences of malignant and suspected mali-gnant lesions were 1.48% and 5.90% respectively. The rate of benign lesions was 78. 60% and that of goiter was 29.15%, Hashimoto＇s thyroiditis 26. 57% and thyroid adenoma 15. 13%. Benign lesions were more common than malignant ones. （2） Comparison of the FNAC and US results of the thyroid nodules showed that of 96 cases with single nodule the rates of malignancy and suspected malignancy were 3. 12% and 7.29%, but of 137 cases with multiple nodules the rates of the two lesions were 0. 73% and 6. 57%. In 108 cases with smaller nodules （ ≤ 1.5 cm） the rate of malignancy and suspected malignancy found with FNAC were 0. 93% and 7.41%, while in 125 cases with greater nodules （ 〉 1.5 cm） the rate of the two lesions were 2.40% and 6.42%. In 99 solid nodules the rates of malignancy and suspected malignancy were 2.02% and 12. 12%, while in 85 cystic or mixed nodules the rates of the two lesions were 2. 35% and 2. 35%. In the above-mentioned three groups, only the suspected malignancy rate in solid nodules was higher than these in cystic or mixed ones with significant difference （P =0. 013）. （3） As compared with the cytological and histological diagnoses in 24 cases, the diagnostic accuracy of FNAC was 75.00% and the rates of false positive and false negative were 25.00% and 0, respectively. Conclusions The common causes of the thyroid nodules detected in physical examination are goiter, Hashimoto＇s thyroiditis and thyroid adenoma. FNAC is a reliable method to define the benign or malignant nature of thyroid nodules with a high diagnostic accuracy. US features of the nodule alone, no matter it is single, solid or of greater size do not sufficiently increase the incidence of thyroid carcinoma.