超声引导下粗针组织活检对甲状腺结节诊断的意义

Significance of Ultrasound-Guided Core Needle Biopsy in Diagnosis of Thyroid Nodules

目的探讨超声引导下粗针组织活检（CNB）对甲状腺结节诊断的价值。方法回顾性分析347例甲状腺结节患者的临床资料,对患者超声引导下CNB及术后石蜡病理学结果进行比较。结果所有患者均穿刺成功,活检取材满意度为100%;2例出现穿刺后局部血肿,经保守治疗后缓解。347例患者CNB病理学结果显示：117例考虑为恶性,其中115例为甲状腺乳头状癌,1例为未分化腺癌,1例为鳞癌;230例考虑为良性,其中53例为甲状腺炎,141例为结节性甲状腺肿,16例为甲状腺腺瘤,20例为结节性甲状腺肿合并甲状腺炎。132例行手术治疗（113例穿刺病理学结果为恶性,19例穿刺病理学结果为良性）,其中127例穿刺病理学结果与术后石蜡病理学结果相符,5例为假阴性。132例手术患者中,结节直径≤0.5 cm者4例,0.5-1 cm者59例,1-2 cm者46例,〉2 cm者23例,其穿刺病理学结果准确率分别为75.0%（3/4）、98.3%（58/59）、97.8%（45/46）和91.3%（21/23）,提示结节直径在0.5-2 cm者穿刺病理学结果符合率最高。超声引导下CNB对甲状腺结节良、恶性鉴别诊断的准确率、敏感性、特异性、阳性预测值、阴性预测值、漏诊率和误诊率分别为96.21%（127/132）、95.76%（113/118）、100%（14/14）、100%（113/113）、0.74（14/19）、4.24%（5/118）和0（0/14）。结论超声引导下CNB对甲状腺结节具有很高的鉴别诊断价值,对甲状腺结节的治疗有重要的指导意义。

Objective To explore the value of ultrasound-guided core needle biopsy（CNB） in diagnosis of thyroid nodules.Methods The clinical data of 347 patients with thyroid nodules who underwent ultrasound-guided CNB were retrospectively analyzed,and the results of CNB pathology were compared with postoperative wax pathology results.Results All patients completed CNB successfully and satisfaction rate for tissue samples was 100%.After CNB,local hematoma occurred in two cases and relieved by conservative therapy.The CNB pathology results of 347 cases of patients were as follows： 117 cases were malignancy,including papillary thyroid cancer in 115 cases,undifferentiated adenocarcinoma in 1 case,and squamous cell carcinoma in 1 case;230 cases were benign,including thyroiditis in 53 cases,and nodular goiter in 141 cases,adenoma in 16 cases,and nodular goitre coexisting thyroiditis in 20 cases.In 132 cases of patients underwent surgery including 113 cases of malignancy and 19 cases of benign disease,the CNB pathology results in 127 cases were consistent with postoperative wax pathology results and false negative occurred in 5 cases.The diameter of thyroid nodules were not more than 0.5 cm in 4 cases,0.5-1.0 cm in 59 cases,1-2 cm in 46 cases,and more than 2 cm in 23 cases,and the accuracy rate of CNB pathology results was 75.0%（3/4）,98.3%（58/59）,97.8%（45/46）,and 91.3%（21/23）,respectively,which was the highest in 0.5-2.0 cm.The accuracy,sensibility,specificity,positive predictive value,negative predictive value,failure rate,and misdiagnosis rate of ultrasound-guided CNB for differential diagnosis of thyroid malignant nodules from benign nodules were 96.21%（127/132）,95.76%（113/118）,100%（14/14）,1（113/113）,0.74（14/19）,4.24%（5/118）,and 0（0/14）,respectively.Conclusion Ultrasound-guided CNB has important value on differential diagnosis of thyroid nodules,and important guiding significance on treatment of thyroid diseases.