持笔式持续负压细针穿刺针诊断83例甲状腺肿物的体会

Experience of diagnosing 83 cases of thyroid neoplasm by applying fine needle aspiration cytopathology

目的:通过应用一次性持笔式持续负压细针穿刺针对83例甲状腺肿块的细针穿刺检查,探讨甲状腺肿物细针穿刺的准确率及误诊原因,推广一次性持笔式持续负压细针穿刺检查在基层医院中的应用。方法:对83例甲状腺肿物患者进行细针穿刺诊断检查,与术后病理组织学诊断相对比,分析细针穿刺细胞学检查与组织后病理检查的诊断符合率及误诊原因。结果:83例甲状腺肿物中,良性结节70例,滤泡性肿瘤6例,乳头状癌7例;83例细针穿刺细胞学检查与组织学诊断符合率为97.6%。7例甲状腺乳头状癌中1例误诊为微小乳头状癌,误诊原因是癌变的部位较局限,造成漏诊。6例滤泡性肿瘤中1例误诊为乳头状癌,误诊原因是嗜酸细胞性肿瘤可出现乳头状改变,细胞核呈现多形性,与乳头状癌有一定的相似性,通过术中冰冻病理检查进行鉴别。结论:细针穿刺诊断甲状腺良性结节的准确率高,是值得临床医生信赖的快速早期微创的检查技术。应用一次性持笔式持续负压细针穿刺针较传统的细针穿刺能获得更多的标本量,成功率更高,与常规组织病理诊断的符合率高,能提高细针穿刺的准确性。一次性持笔式持续负压细针穿刺针FNAC对设备要求很低,操作简单,价格低廉,对患者造成的痛苦少,安全,适宜在基层医疗单位开展甲状腺肿物的早期诊断。

Objective： To explore the diagnostic accuracy and reasons of misdiagnosis of 83 cases of thyroid neoplasm by disposable fine needle aspiration eytopathology （FNAC）, and popularize fine needle aspiration cytopathology in basic hospitals. Methods： 83 cases of thyroid neoplasm was developed pathological diagnosis by disposable fine needle aspiration cytopathology and histopathology, and the reasons of misdiagnosis in diagnosing thyroid neoplasm by FNAC was analyzed. Results： Among 83 cases of thyroid neoplasm, 70 cases were benign nodules, 6 cases were follicular tumor, and 7 cases were papillary carcinoma in thyroid neoplasm, the accurate in diagnosing thyroid neoplasm was 97.6%. In 7 cases of thyroid papillary carcinoma, 1 case was misdiagnosed as moero papillary carcinoma, and the reason was the limited location of cancer. In 6 cases of follicular tumor, 1 case was misdiagnosed as papillary carcinoma, and the reason was acidophile cell cancer had papillary changes, cells presented pantomorphia, and similar as papillary carcinoma, and can be identified by frost pathology. Conclusion： The accuracy is high, and could be used by clinical doctors as a technique of fast early examination. It can get more sample, whereas more simple and cheap, so this technique suits for applying in basic hospitals.