甲状腺乳头状癌中针吸穿刺细胞学的诊断及漏诊原因分析

The value of fine needle aspiration cytology in the diagnosis of thyroid papillary carcinoma

目的探讨针吸穿刺细胞学(fine needle aspiration cytology,FNAC)对甲状腺乳头状癌的诊断价值。方法收集新疆医科大学第一附属医院206例术后诊断甲状腺乳头状癌、术前行甲状腺针吸穿刺细胞学检查的患者相关资料,其中76例制备细胞蜡块。对涂片中细胞的排列结构、细胞核的特点以及背景特点进行观察;细胞蜡块行HE染色和免疫组织化学标记。结果 206例针吸穿刺的甲状腺结节患者中,189例诊断为甲状腺乳头状癌,17例漏诊,0例误诊。诊断的准确率为91.75%,漏诊率为8.25%,误诊率为0%。结论 FNAC对甲状腺乳头状癌具有重要的术前诊断价值,可作为临床确诊的首选检查方式,对临床的进一步治疗具有指导性意义。甲状腺结节的大小、部位、距体表的距离及伴发的基础疾病作为漏诊因素,需要细胞学医师提高警惕。

Objective To explore the diagnostic value of fine needle aspiration cytology （FNAC） in the diagnosis of papillary thyroid carcinoma. Methods 206 cases of clinical samples were enrolled that were pathologically diagnosed with papillary thyroid carcinoma after thyroidectomy and underwent FNAC before thyroidectomy whose clinicopathological information was available. Of which, 76 cases were prepared for cell blocks. Cellular architecture, featured nucleus as well as background were observed; cell blocks were subjected to hematoxylin-eosin （HE） staining and relevant immunohistochemical immunostaining. Res- ults In 206 cases obtained by FNAC, 189 cases were diagnosed as papillary thyroid carcinoma, and 17 cases were missed diagnosis, and no case was misdiagnosis. The accuracy was 91.75%, and missed diagnosis rate was 8.25 %, and misdiagnosis rate was 0 %. Conclusion It can be seen that FNAC has important diagnosis value for the diagnosis before thyroidectomy; therefore it could be first option for clinical workup, providing guidance meaning for further clinical therapy. In addition, the cytologists should be aware of sev- eral following aspects that may lead to missed diagnosis, whose distance from body surface and its accompanying including the size and location of thyroid nodules basic diseases, all of these could be factors for missed diagnosis of papillary thyroid carcinoma.