超声引导下细针吸取活检对甲状腺囊实性结节与实性结节的诊断价值比较

Diagnosis of thyroid nodules with ultrasound-guided fine needle aspiration： comparison of solid lesion and complex lesion

目的比较超声引导下细针吸取细胞学检查（US-FNA）对不同大小的甲状腺囊实性及实性结节的诊断价值。方法对168例患者的i75个甲状腺结节进行US-FNA检查。将穿刺细胞学及组织学的诊断资料与手术病理及临床随访结果进行对照分析。63例患者获得手术病理，其余病例进行临床随访，随访时间2年3个月至6年2个月。结果175个甲状腺结节中实性及囊实性结节分别为115个和60个。US-FNA检查均未出现严重并发症。经手术及随访证实实性结节中甲状腺癌36例，囊实性结节中甲状腺癌3例。实性结节及囊实性结节涂片不满意率分别为7％和8％。US-FNA对囊实性和实性甲状腺癌的诊断准确性相近（88．8％对94．6％，），但前者诊断敏感性较低。对≤1cm及〉1cm实性甲状腺癌诊断敏感性及准确性相似（敏感性75．0％对83．9％，准确性94．1％对86．3％）。结论US-FNA对不同大小的甲状腺实性及囊实性结节取材满意，诊断准确性好，有较高的临床应用价值。

Objective To compare the efficacy of ultrasound-guided fine-needle aspiration（US-FNA） biopsy in diagnosing solid and complex thyroid nodules with different size. Methods One hundred and seventy-five thyroid FNA biopsies were prospectively performed on 168 patients ranging from 4 to 75 years of age. Sixty-three nodules were surgically excised and the others were clinically followed-up. The cytology diagnoses were categorized into four groups., benign, malignant, suspicious and unsatisfactory. Results There was no significant complication in the all 115 solid and 60 complex thyroid lesions and there were 36 and 3 malignant nodules respectively in solid and complex thyroid nodules. The nondiagnostic rates of solid and complex nodules were 7% and 8%. The accuracy of US-FNA in diagnosing complex thyroid nodules was comparatively equal to that of in solid thyroid nodules. In solid thyroid nodules, the sensitivity and accuracy in 41 cm group were similar to that of in 〉1 cm group. Conclusions US-FNA was an accurate and reliable method to diagnose thyroid solid and complex lesions.