超声引导下粗针穿刺活检在甲状腺疾病诊断中的应用

Application of ultrasound-guided core needle biopsy in diagnosis of thyroid diseases

目的本研究旨在探讨超声引导下粗针穿刺活检对于根据症状、体征、实验室检查及各种影像学检查不能明确诊断的甲状腺疾病的临床应用价值。方法回顾分析2011-11～2012-12在我院门诊及病房就诊的甲状腺结节或弥漫性病变待查的相关甲状腺疾病超声引导下穿刺的60例患者的的临床资料及其组织及细胞学诊断结果,在为患者行甲状腺穿刺活检前,均进行甲状腺功能、甲状腺自身抗体检测以及甲状腺彩超检查、血常规及出凝血指标检测等。结果本组病例穿刺活检成功率为98.3%,确诊率为95%;60例患者中,甲状腺乳头状癌15例(25%),甲状腺髓样癌1例(0.17%),结节性甲状腺肿22例(36.7%),甲状腺囊肿12例(20%),桥本氏甲状腺炎6例(10%),甲状腺腺瘤1例(0.17%)。其中16例甲状腺癌及1例甲状腺腺瘤穿刺活检病理与术后病理诊断完全相同,诊断符合率100%。结论超声引导甲状腺粗针穿刺活检安全可靠,不仅对甲状腺的结节病变有较高的鉴别诊断价值,对甲状腺癌的早期检出率有重要作用,而且对甲状腺囊性病变亦有较安全的治疗作用。

Objective To explore the clinical value of ultrasound-guided core needle biopsy in diagnosing thyroid diseases which were unable to definitively diagnose according to symptom, sign and laboratory or imaging examination. Methods Ultrasound-guided core needle biopsy was performed in 60 patients with thyroid nodule and diffuse lesion in Beijing Hospital from November 2011 to December 2012. The clinical data and their histodiagnosis or cytodiagnosis results were collected and retrospectively analyzed. Thyroid function, thyroid autoantibodies, blood routine examination, hemorrhage and coagulation indicators and thyroid CDFI were done before biopsy. Results The successful rate of needle biopsy was 98.3% and the definitive diagnosis rate was 95 %. Of 60 cases, there were 15 cases （25 % ） of papillary thyroid carcinoma, 1 case （0.2%） of medullary thyroid carcinoma,22 cases （36.7 % ） of nodular goiter, 12 cases （20%） of thyroid cyst,6 cases（ 10% ） of Hashimoto＇ s thyroiditis and 1 case（0.2% ） of thyroid adenoma. The pathological diagnosis results by needle biopsy in 16 cases of thyroid carcinoma and 1 case of thyroid adenoma were identical with the postoperative pathology, and the diagnostic accordance rate was 100%. Conclusion Ultrasound-guided core needle biopsy is safe and reliable,which not only has high value for differentially diagnosing the thyroid nodule and early detecting the thyroid cancer, but also has a safe therapeutic effect on thyroid cystic lesions.