超声引导下细针穿刺活检对≤10mmTI—RADS4a类甲状腺结节的诊断价值

Diagnostic value of ultrasound-guided fine.needle biopsy for imaging reported and data system 4a thyroid nodules ≤ 10 mm

目的探讨超声引导下细针穿刺活检（US—FNAB）对甲状腺超声影像报告和数据系统（TI—RADS）4a类且直径≤10mm甲状腺结节的诊断价值。方法回顾性分析接受US—FNAB检查的甲状腺结节患者的超声特征，根据TI-RADS评估每个结节的恶性特征并进行分类，将其中TI—RADS4a类且直径≤10mm365例患者的甲状腺结节均行US．FNAB检查，并根据超声测量结节最大径分为〈5mm组和5．10mm组．对细胞学诊断结果与病理结果进行对照分析。结果365例TI-RADS4a类结节中，细胞学诊断恶性68例，可疑恶性81例，良性193例，不满意6例，不确定17例；经术后病理或临床随访，恶性153例，良性212例，US—FNAB细胞学结果和实际病理结果无明显差别（P〉0．05）。5～10mm组结节的细胞学阳性率和实际恶性率均大于〈5mm组（P〈0．05）。US-FNAB细胞学诊断TI—RADS4a类甲状腺结节的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为92．2％、96．2％、94．6％、94．4％和94．5％。结论US-FNAB检查对TI-RADS4a类甲状腺结节有较高的诊断价值。能有效提高术前诊断的准确性。

Objective To explore the diagnostic value of ultrasound guided fine needle aspiration biopsy （US-FNAB） for thyroid imaging reported and data system （TI-RADS） 4 class - 10 mm thyroid nodules. Methods The preoperative ultrasound features of patients with thyroid nodule who received US- FNAB examination were retrospectively analyzed, the malignant risk of each nodule was evaluated and classified according to TI-RADS. TI-RADS 4a class thyroid nodules and diameter ≤ 10 mm of 365 patients were classified as suspicious nodules and received US-FNAB examination. The nodules were classified as 〈 5 mm and 5 - 10 mm groups. The results of cytologic diagnosis were compared with the pathological diagnosis,and the differences for nodules with different size were analyzed. Results Among 365 TI-RADS 4 class thyroid nodules diagnosed by the cytology, 68 nodules were malignant; 81 nodules were suspicious of malignancy; 193 nodules were benign; 6 nodules were unsatisfactory; and 17 nodules were undetermined. According to postoperative pathology or follow-ups, 153 nodules were malignant and 212 nodules were benign. The difference between US-FNAB results and pathology was not significant （ P 〉 0. 05 ）. Cytologic positive rate and actually malignant rate of the nodules in 5 - 10 mm group were higher than 〈5 mm groups （ P 〈 0. 05 ）. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US-FNAB cytological diagnosis of TI-RADS 4 class thyroid nodule were 92. 2% , 96. 2%, 94. 6% ,94.4% and 94. 5% ,respectively. Corldusion US-FNAB examination is valuable for the diagnosis of TI-RADS 4a class thyroid nodules and improves the preoperative diagnosis.