病理技术因素对甲状腺结节P-FNAC诊断准确性的影响

Influencing factors on diagnostic accuracy of palpable fine-needle aspiration cytology in thyroid nodules

目的评估影响甲状腺结节触诊细针穿刺细胞学诊断(P-FNAC)准确性有关的病理技术因素。方法收集行P-FNAC检查并经外科手术切除的甲状腺结节息者136例,回顾其活检和细胞学结果 ,将患者分成5等级:1级,不确定14例;2级,良性48例;3级,不典型23例;4级,可疑恶性24例;5级,恶性27例;其中4和5级视为阳性,1、2和3级视为阴性。探讨不同穿刺技巧、制片和染色因素对P-FNAC检查诊断准确率的影响。结果 P-FNAC的阳性准确率为79.41%,敏感度84.31%,特异度76.47%,阳性预测值为68.25%,阴性预测值为89.04%。是否血液稀释对诊断甲状腺恶性结节有较明显影响(P<0.05)。Logistic多元回归分析结果证实穿刺次数、血液稀释以及染色类型对P-FNAC阳性率有显著影响(P<0.05或0.01)。结论规范P-FNAC穿刺操作及染色技术对甲状腺结节诊断准确性具有重要作用。

Objective To evaluate the influencing factors on diagnostic accuracy of palpable fine- needle aspiration cy-tology （P- FNAC） in thyroid nodules. Methods One hundred thirty- six patients with thyroid nodules underwent surgical resec-tion, preoperative P- FNAC was performed in all patients. According to cytological results of biopsy, the patients were classified as：grade 1 （undifined, n=14）, grade 2 （benign, n=48）, grade 3 （atypical, n=23）, grade 4 （suspicious malignant, n=24）, grade 5 （malignant, n=27）, among which grades 4 and 5 were taken as positive and grades 1- 3 as negative. The influence of aspirating technique, slide- making and staining on diagnostic accuracy of P- FNAC was evaluated. Results The overal accuracy rate of palpable FNAC was 79.41%. The sensitivity, specificity, positive predictive value and negative predictive value of P- FNAC were 84.31%, 76.47%, 68.25%and 89.04%, respectively. Layered chi- square test showed that hemodilution significantly affected the diagnostic accuracy for malignant thyroid nodules（P〈0.05）. Multiple logistic regression analysis revealed that the times of aspi-ration, hemodilution and types of staining significantly affected the accurate rate of P- FNAC （P〈0.01 or 0.05）. Conclusion To improve the diagnostic accuracy of thyroid nodules it is necessary to standardize the aspiration procedure and staining tech-nique of P- FNAC.