甲状腺细针穿刺手感联合细胞学检查对甲状腺结节良恶性的研究

Diagnostic value of puncture feeling combined with fine-needle aspiration cytology for thyroid nodules

目的探讨穿刺手感联合甲状腺细针穿刺细胞学检查（fine—needle aspiration cytology，FNAC）在甲状腺良恶性结节鉴别诊断中的应用价值。方法行FNAC并经手术病理证实的1014个甲状腺结节，其中86个结节行两次FNAC，根据BethesdaSystem分类标准进行细胞学诊断，记录甲状腺细针穿刺手感，在双盲条件下，用Kappa方法检验同一穿刺者和不同穿刺者同一结节前后两次穿刺手感的一致性。结果1014个结节中，经手术病理证实为良性结节263个，恶性结节751个，穿刺手感联合FNAC诊断甲状腺结节的敏感性、准确率明显高于两者单独应用，差异有统计学意义（分别x^2=11．609，4．433，P=0．00，0．04；X。=19．369，6．697，P=0．00，0．01）。单独应用FNAC与穿刺手感诊断甲状腺结节的敏感性、准确率差异无统计学意义（x^2=1．230，0．242，P=0．27，0．62）。在双盲条件下，同一穿刺者与不同穿刺者同一结节前后两次穿刺手感的一致性很高（Kappa=0．829，P=0．00；Kappa=0．885，P=0．00）。结论穿刺手感联合FNAC有助于提高诊断甲状腺结节良恶性的敏感性、准确率，且穿刺手感具有较高的重复性。

Objective To evaluate the diagnostic value of puncture feeling combined with fine-needle aspiration cytology （FNAC） for thyroid nodules. Methods One thousand and fourteen thyroid nodules were retrospectively analyzed. Eighty-six thyroid nodules were performed repeat FNAC. All nodules were confirmed by pathology, the agreement of puncture feeling at different time was evaluated by Kappa test. Results There were 751 malignant nodules and 263 benign nodules. Sensitivity and accuracy of FNAC combined with puncture feeling were higher than those of single FNAC or single puncture feeling （X^2 = 11.609,4.433 andP =0.00,0.04;X%2 = 19.369,6.697 and P = 0.00,0.01,respectively）. There were no statistically differences in the sensitively and accuracy between single FNAC and puncture feeling （X^2 = 1. 230,0. 242 and P = 0.27,0.62, respetively）. The Kappa values of inter-observer and intra-observer were 0. 829（ P = 0.00） and 0. 885 （ P = 0.00） respectively with statistically significance. Conclusions Puncture feeling combined with FNAC can improve the sensitivity and accuracy in the diagnosis of thyroid nodules, the reproducibility of puncture feeling is excellent.